5530 


A   TREATISE 


ACUTE  AND  CHRONIC  DISEASES 


NECK  OF  THE  UTERUS. 


ILLUSTRATED    WITH 


NUMEROUS   PLATES.   COLORED  AND   PLAIN. 


BY 

CHARLES  D.  MEIGS.  M.D., 

PROFESSOR  OF  MIDWIFERY  AND  THE  DISEASES  OF  WOMEN  AND  CHILDREN  IN  JEFFERSON   MEDICAL  COLLEGE; 
MEMBER  OF  THE  AMERICAN  MEDICAL  ASSOCIATION;    OF  THE  AMERICAN  PHILOSOPHICAL  SOCIETY, 
AND  ONE  OF  THE  COUNCIL;    VICE-PRESIDENT  OP  THE  PHILADELPHIA  COLLEGE  OF  PHY- 
SICIANS;  AUTHOR  OF  "OBSTETRICS,  THE  SCIENCE  AND  THE  ART;"  "WOMAN, 
HER  DISEASES  AND  REMEDIES:"   "  A  TREATISE  ON  CERTALS  OS 
THE  DISEASES  OF  YOUNG  CHILDREN,"  ETC.  ETC. 


PHILADELPHIA: 
BLANC  II  ABD     AND    LEA 

1854. 


Entered  according  to  the  Act  of  Congress,  in  the  year  1854,  by 

BLANCIIARD    AND    LEA, 

in  the  Office  of  the  Clerk  of  the  District  Court  of  the  United  States  in  and  for  the 
Eastern  District  of  Pennsylvania. 


PHILADELPHIA: 
T.   K.  AND  P.  G.  COLLINS,  PRINTERS. 


rarj 

WP 
if  70 

TO 

ROBERT  M.  HUSTON,  M.D., 

PROFESSOR  OF    THERAPEUTICS  AND    THE    MATERIA    MEDICA   IN    JEFFERSON   MEDICAL 
COLLEGE  AT  PHILADELPHIA. 

My  dear  sir  : — 

You  are  aware,  I  believe,  that  by  command  of  the 
American  Medical  Association,  I  was  directed,  as  chair- 
man of  a  committee  appointed  at  Charleston,  South 
Carolina,  to  present  a  Report  to  that  body  on  the  subject 
of  Acute  and  Chronic  Diseases  of  the  Cervix  Uteri. 

Professor  Channing,  of  Boston,  and  Dr.  Thomas  H. 
Yardley,  of  Philadelphia,  who  were  of  the  committee, 
confided  to  me  the  duty  of  drawing  up  the  Report, 
which  was  presented  to  the  Association  at  the  New  York 
meeting  in  May,  1853. 

The  paper,  with  the  drawings,  was  ordered  to  be 
printed  and  engraved,  and  may  be  found  in  the  last 
volume  of  the  Transactions. 

Under  the  impression  that  the  views  of  disease  and 
suggestions  of  treatment  in  this  paper  might,  if  more 
generally  diffused,  prove  of  some  service  to  our  profes- 
sional brethren,  I  have,  with  the  liberal  consent  and 
full  approval  of  the  publishing  committee,  made  a  sepa- 
rate volume  of  the  Tract,  which  I  beg  you  to  allow  me 
to  dedicate,  thus  publicly,  to  you.      I  hope  you  will 

6124024 


IV  DEDICATION. 

accept  it  as  a  mark  of  my  most  sincere  respect  and  warm 
attachment.  I  pray  you  also,  as  far  as  you  properly 
may,  overlook  its  numerous  faults  of  substance  and 
form ;  to  receive  my  book  with  wonted  kindness,  and 
continue  to  favor  me,  as  long  as  I  live,  with  that  course 
of  kind  and  friendly  conduct,  which,  together  with  my 
high  appreciation  of  your  sterling  abilities  and  candor 
as  a  man,  has  long  made  me,  and  ever  shall  make  me, 
feel  that  I  ought  to  be,  and  am  your  sincere  and  re- 
spectful friend  and  most  grateful  servant, 

CHARLES  D.  MEIGS. 

324  Walnut  Street, 
Jan.  15,  1854. 


ON 


ACUTE  AND  CHRONIC  DISEASES 


THE  NECK  OF  THE  UTERUS. 


The  great  prevalence  of  cases  of  sexual  disorders 
has  of  late  called  much  of  the  attention  of  physi- 
cians to  a  consideration  of  the  causes,  signs,  and  treat- 
ment of  those  affections,  and  several  recent  publications 
have  thrown  much  light  on  them.  It  was  to  be 
expected  that  the  labors  of  ingenious  men,  devoted 
to  this  species  of  research,  should,  by  this  time,  have 
placed  all  questions  in  this  kind  of  practice  so  fairly 
before  us,  and  with  solutions  of  the  various  problems  so 
clearly  exposed,  that  there  could  be  no  farther  real 
necessity  for  making  public  one's  observations  or  reflec- 
tions. 

It  is,  nevertheless,  undeniable  that  our  daily  clinical 

experience,  as  well  as  what  we  notice  of  the  current 

medical    literature,   and   what   we   behold    around   us 

among  the  sick,  all  concur  to  prove  that  it  is  in  general 

2 


18  ACUTE   AND    CHRONIC    DISEASES 

esteemed  to  be  a  difficult  thing  to  comprehend  the  va- 
rious disorders  of  the  womb,  and  appreciate  their  pecu- 
liar reaction  upon  the  constitutions  of  women. 

Notwithstanding  the  numerous  learned  works  we 
possess,  whether  they  be  of  ancient  date  or  modern,  it 
does  appear  to  me  that  this  class  of  disorders,  as  to  the 
clinical  duties  at  least  that  are  connected  with  them, 
are  not  so  well  understood  as  they  ought  to  be,  and 
that  this  is  the  chief  reason  why  so  many  of  the  cases 
tend,  at  last,  to  fall  under  the  care  of  a  few  individuals, 
who  may  have  acquired  a  sort  of  fame  or  notoriety  for 
success  in  their  treatment,  instead  of  remaining,  as  they 
ought,  in  charge  of  the  family  physician  or  surgeon, 
usually  the  first  to  be  consulted  on  account  of  them. 

I  regard  this  tendency  to  specialization  as  a  thing 
most  injurious  to  the  profession,  which  ought  to  be  a 
whole  in  the  whole  and  a  whole  in  every  part.  Such 
specialization  of  the  office  of  the  physician  is  very  far 
from  tending  to  elevate  the  whole  body  in  its  usefulness 
to  the  public,  however  it  may  serve  to  exalt  the  inte- 
rests of  a  few  individuals,  and  it  must  be  confessed  that 
any  specialization  as  to  this  sort  of  clinical  duties  is 
both  highly  inconvenient  to  the  people,  and  disparaging 
to  the  profession  at  large,  while  it  is  wholly  uncalled 
for  by  the  nature  of  the  cases.  A  little  consideration 
might  serve  to  convince  us  that  this  class  of  disorders 
presents  to  the  practising  physician  nothing  more  essen- 
tially inscrutable,  or  intractable,  than  the  ordinary  com- 
plaints submitted  for  examination  and  advice  to  the 
gentlemen  of  the  Art. 


OF  THE  NECK  OF  THE  UTERUS.        19 

There  would  be  less  propensity  to  bring  them  into 
the  class  of  a  specialty  in  practice,  if  the  treatises  now 
in  our  possession,  were  as  clear  in  the  description  and 
illustration  of  disease,  and  as  precise  in  the  indication 
and  relation  of  methods,  as  they  ought  to  be.  Far  from 
this — we  have  to  regret  that  many  of  the  drawings  and 
colored  prints  serve  rather  to  obscure,  than  enlighten 
the  path  of  the  practitioner.  It  needs  only  to  glance, 
for  example,  at  the  plates  to  Madame  Boivin's  work,  to 
see  that  this  remark  is  quite  just,  while  the  more  ele- 
gant volume  of  Dr.  Hooper  affords  as  little  aid — his 
engravings,  however  beautiful,  exhibiting  for  us  only 
the  ravages  of  diseases  ended  in  death,  and  not  those 
curable  forms  and  stages,  which  are  far  more  worthy  of 
investigation,  as  guiding  us  in  our  attempts  to  cure. 

It  has  seemed  to  the  Author,  that,  before  entering 
upon  the  examination  and  description  of  the  special 
cases,  he  is  called  upon  for  a  few  remarks  concerning 
methods  of  proceeding — the  usefulness  and  propriety  of 
which  have,  by  some,  been  sharply  called  in  question, 
while  others  have  contended  that  they  are  indispensable 
to  correct  diagnostication  and  treatment. 

I  allude  to  the  method  introduced  by  M.  Recamier, 
Physician  to  the  Hotel  Dieu,  at  Paris.  That  celebrated 
professor,  in  his  work  entitled  Recherclies  sur  le  Traite- 
ment  clu  Cancer,  2  vols.  8vo.  Paris,  1829,  says,  at  page 
317,  t.  i.  :— 

"  Des  l'annee  1801,  consulte  frequemment  pour  des 
maladies  organiques  de  l'uterus,  je  coinmencai  a  traiter 


20  ACUTE   AND   CHRONIC    DISEASES 

les  ulceres  du  vagin  et  du  museau  de  tanche  de  la 
merae  maniere  que  ceux  de  la  gorge,  qui  m'en  donne- 
rent  l'idee.  Un  tub  d'etain  du  volume  du  doigt,  et  de 
quatre  ou  cinq  pouces  de  long,  servait  a  ces  panse- 
ments,  dans  lesquels  les  surfaces  ulcerees  etoient 
touchees  avec  un  pinceau  de  charpie  trempe  dans  du 
miel  rosat,  ou  dans  du  rob  de  Daucus,  seul  ou  associe 
avec  du  collyre  de  Lanfranc,  du  laudanum  de  Rousseau, 
ou  de  l'extrait  d'opium." 

M.  Recamier  farther  informs  us,  that,  in  1812,  M. 
Bayle  inquired  of  him  concerning  his  methods,  and  that 
the  facts  he  communicated  to  that  author  were  made 
public  in  the  Diet,  des  Sci.  Med.,  art.  Cancer,  which 
notice  is  found  in  torn.  iii.  p.  604,  as  follows : — 

"  Deja  M.  Recamier  est  parvenu  a  porter  differentes 
substances  medicamenteuses  immediatement  sur  l'ulcere, 
a  l'aide  d'un  pinceau  conduit  dans  un  tube  de  gomme 
elastique  ou  de  metal  qui  ecarte  les  parois  du  vagin,  et 
embrasse  dans  son  orifice  superieure  toute  la  partie 
saillante  du  col  de  i'uterus.  Ces  essais,  conduits  avec 
prudence,  conduiront  peutetre  un  jour  a  quelque 
methode  de  traitement,  plus  efficace  que  celles  aux 
quelles  nous  sommes  encore  reduits." 

The  great  success,  in  treatment,  that  attended  M. 
Recamier's  practice  at  the  Hotel  Dieu  and  the  city  ge- 
nerally, led  to  the  introduction  of  Ms  method,  which 
may  be  denominated  the  surgical  method  of  curing  the 
disorders  of  the  cervix;  and  the  question  now  is, 
whether  the  advantages  resulting  from  it  are  sufficient 
to  counterbalance  certain  evils  supposed  to  have  grown 


OF  THE  NECK  OF  THE  UTERUS.        21 

out  of  its  introduction.  These  evils,  it  is  alleged, 
consist  in  the  great  mortification  which  any  sensible 
woman  must  experience,  if  subjected  to  a  metroscopic 
examination — some  laxity  of  the  moral  sense  likely  to 
grow  out  of  such  proceedings — the  physical  injury,  by 
contusion  or  laceration,  sometimes  attending  the  opera- 
tion, and  the  mischievous  effects  of  violent  drugs  and 
dangerous  instruments,  to  the  employment  of  which  it 
leads  and  tempts  us.  Farther — it  is  asserted  to  be  un- 
necessary, since  the  exploration  by  touching,  as  it  is 
called,  reveals  sufficiently  well  the  nature  of  diseases  at- 
tacking the  cervix  uteri. 

I  shall  not  here  discuss  the  moral  differences  between 
a  diagnosis  made  by  the  operation  of  touching,  and  a 
metroscopic  one.  Either  of  them  is  bad  enough,  in 
itself  considered ;  but  as  neither  of  them  could  be  sup" 
posed  possible,  except  out  of  some  direful  necessity  of 
the  patient,  and  as  the  one  is  not  essentially  more  revolt- 
ing to  the  feelings  of  the  sufferer  than  the  other,  it  ap- 
pears to  me  that  the  argument  is  as  valid  against  the 
one  as  the  other.  No  one  will  deny  that  the  delicacy 
of  those  relations  that  exist  between  medical  people 
and  their  female  patients,  opposes,  in  a  variety  of  cases, 
an  insuperable  barrier  against  any  successful  treatment 
whatever,  for  there  are  found  individuals  so  fastidious 
as  to  prefer  pain,  disease,  and  even  death  itself,  to 
any  revelation  concerning  their  disorders. 

Some  women,  who  do  not  object  to  relate  the  history 
of  their  diseased  sensations,  compel  us  to  rest  satisfied 
with  such  barren  histories  as  they  themselves  can  give, 


22  ACUTE    AND    CHRONIC    DISEASES 

and  medical  men,  it  is  presumed,  are  often  obliged  to 
adopt  an  empirical  method,  or — to  use  a  common  phrase 
— to  guess  at  the  seat,  nature,  and  phasis  of  the  disease, 
as  well  as  the  remedies  for  it,  rather  than  resign  the 
woman  to  hopeless  distress  on  the  one  hand,  or,  on  the 
other,  urgently  insist  upon  her  waiver  of  that  fastidious 
sentimentality  which  ought,  to  a  certain  extent,  to  rule 
her  professional  relations  with  the  medical  adviser,  but 
not  wholly  and  exclusively,  and  to  her  ruin. 

Even  to  examine  by  Touching,  does,  in  many  parts  of 
the  United  States,  appear  to  be  a  revolting  proposition ; 
and  there  are  some  persons  who  prefer  to  make  jour- 
neys of  hundreds  of  miles,  in  order  that  such  an  inquiry, 
supposing  it  indispensable,  may  be  instituted  by  a  stran- 
ger, and  far  from  home.  Some  examination  is,  never- 
theless, often  an  indispensable  requisite  to  correct  infor- 
mation as  to  the  sanitary  wants  of  the  patient ;  and 
physicians  cannot  always  rely  upon  the  historical  relation 
of  the  patient  herself  or  her  friends,  who  assuredly  can- 
not impart  knowledge  which  they  do  not  themselves 
possess,  and  can  by  no  possible  means  acquire. 

It  may  be  farther  averred,  that  the  Touch  alone  does 
not  surely  impart  this  knowledge ;  for  as  much  as  a 
tint  or  color  is  often  the  clearest  exponent  of  a  morbid 
state,  it  becomes  sometimes  an  imperious  necessity  to 
ascertain  it  by  the  metroscope.  The  question  is,  then, 
not  whether  the  instrument  informs  us  better,  but 
whether,  without  its  aid,  we  could  at  all  learn  our  the- 
rapeutical or  surgical  duty  to  the  subject. 

The  objection  as  to  danger  of  injury,  and  that  other, 


OF  THE  NECK  OF  THE  UTERUS.        23 

the  temptation  to  make  use  of  too  violent  topical  remedies, 
is  a  question  of  the  good  sense  and  prudence,  or  con- 
scientiousness of  the  medical  man — subjects  not  for  us 
to  discuss.  Yet,  we  may  adventure  the  remark,  that  no 
sincere  person  will  deny,  that,  in  our  profession  in  these 
United  States,  there  exists  a  great  majority  of  gentle- 
men, competently  educated ;  men  skilled  in  their  art ; 
men  of  probity,  and  having  elevated  views  in  morals 
and  religion;  and,  as  to  life  and  conversation,  irre- 
proachable. 

If  the  whole  class  of  cases  under  consideration  should 
be  confided  to  such  persons  as  these,  little  objection 
would  be  made  to  their  professional  opinions  or  practice. 
There  is  conceded  to  them,  by  common  consent,  as  well 
as  by  governmental  authority,  a  "jus  docendi  scribendi 
atque  exercendi,  ubi  rite  vocaii  fuerint ;"  and  the  public 
esteem  them  to  be  warranted  in  all  their  acts,  done 
within  the  metes  and  bounds  of  their  real  professional 
privileges.  They  have  no  authority  to  violate  those 
rules  and  arrogate  privileges  beyond;  and  when  they  do 
so  it  is  at  their  own  peril. 

The  question,  then,  seems  to  be  still  more  narrowed 
down;  and  we  have  only  to  determine  what  is,  and  what 
is  not,  strictly  within  the  limits  of  our  duty  and  preroga- 
tives— things  to  be  resolved,  not  by  formal  council,  but 
by  the  physician  himself,  upon  the  spur  of  the  occasion. 
We  must  not  repudiate,  and,  by  wholesale  reprobation, 
condemn  and  annul  a  good  method  of  cure,  merely  be- 
cause incompetent  or  wicked  persons  might  or  do  abuse 
it  to  their  own  gain :    to  do  so,  would  be  to  amerce 


24  ACUTE    AND    CHRONIC    DISEASES 

and  punish  the  sick  and  the  miserable  for  faults  of  our 
brotherhood. 

Lastly. — Even  if  it  be  true  that  some  abuses,  disgrace- 
ful to  Medicine,  do  exist,  we  are  persuaded  that  such 
discreditable  examples  must  be  very  rare  among  a  class 
so  generally  acknowledged  for  wisdom,  virtue,  and  po- 
liteness, as  the  great  body  of  the  United  States  physi- 
cians. Wherefore,  we  do  not  find  ourselves  called  upon 
to  discountenance  and  reprobate  the  prudent  and  neces- 
sary employment  of  modern  methods  and  instruments, 
invented  to  improve  the  means  both  of  diagnosis  and 
surgical  treatment  of  diseases  of  the  cervix  uteri;  con- 
ceiving that  this  is  a  matter  to  be  left  to  the  conscience 
and  judgment  of  our  brethren,  whenever  the  occasion 
may  arise. 


The  reactions  of  the  reproductive  organs  upon  the 
other  members  of  the  animal  economy  are  known  to  be 
both  diverse  and  comprehensive ;  nor  is  it  difficult  to 
perceive  that  this  should  be  the  case,  seeing  the  great 
importance  of  their  functions.  One  could  hardly  sup- 
pose, indeed,  that  a  system  of  anatomical  tissues,  repre- 
senting the  complement  of  the  vital  powers,  could  be 
an  indifferent  in  their  constitutional  reaction.  The 
powerful  sway  they  exert  upon  not  only  the  physical, 
but  the  psychical  condition  and  nature  of  the  woman, 
might  well  persuade  us  that  changes  in  their  vital  status, 
even  such  as  are  inappreciable  except  by  the  reason, 
should  greatly  affect  both  the  body  and  mind  of  the 
woman. 


OF  THE  NECK  OF  THE  UTERUS.        25 

The  reproductive  force  can  never,  in  fact,  be  an  indif- 
ferent, as  regards  the  health  and  perfection  of  the  woman 
— who  is  always  an  imperfect  being  until  she  has,  at  full 
puberty,  acquired  this  complementary  force,  and  begins 
to  decline  from  her  perfections  as  soon  as  she  lays  it 
down  at  the  change  of  life.  During  all  the  period  in 
which  she  possesses  this  force,  even  very  slight  modifica- 
tions of  it  must  affect  the  direction,  as  well  as  intensity, 
of  many  others  of  her  physiological  actions. 

It  is  probable  that  the  Hysteric  malady,  which  assumes 
such  diverse  forms,  and  comprehends  in  its  range,  so 
many  separate  and  distant  organs,  depends  essentially 
upon  a  vital  status  of  the  reproductive  viscera,  often  so 
slight  as  to  escape  all  sensible  detection.  It  is,  at  least, 
certain  that  sexual  diseases  do  give  rise  to  severe  distress 
in  distant  regions  of  the  body ;  and,  while  they  can  in- 
commode, vex,  and  even  destroy  the  woman  by  degene- 
rating the  womb,  the  ovaries,  or  other  parts,  they  can 
likewise  subvert  her  health,  and  destroy  her  life  by  per- 
verting the  strength  and  soundness  of  other  vital  por- 
tions— the  radiating  point  of  the  mischief  being,  in  the 
mean  time,  concealed  within  the  depths  of  the  pelvis, 
and  wholly  masked  by  the  constitutional  disorders  thus 
set  on  foot  by  it. 

A  dark  and  mysterious  veil  hides  from  us  many  of 
the  laws  that  grow  out  of  the  intimate  relation  and 
mutual  dependency  existing  between  the  conservative 
or  generic  forces  of  animals,  and  their  reproductive  or 
genetic  powers.  Many  stumbling-blocks  in  the  path  of 
the  practitioner  would  be  taken  away,  if  these  laws  and 


26  ACUTE   AND   CHRONIC    DISEASES 

relations  could  be  fully  understood ;  and  we  should  then 
be  able  to  take  more  precise  indications,  and  adopt  more 
positive  methods  of  treatment.  Possessing  full  ana- 
tomical and  physiological  information  upon  those  organs 
and  forces,  we  might  raise  up  in  the  mind  a  true  ideal 
of  them,  which  would  serve  as  a  standard  or  scale  by 
which  to  measure  and  judge  every  aberration  of  form, 
substance,  power,  or  place,  in  the  instances  brought  be- 
fore us  for  our  decision. 

And  it  is  proper,  indeed,  that  the  physician  should, 
in  every  case  of  disease,  endeavor  to  acquire  the  perfect 
idea  of  the  organ  whose  state  he  is  about  to  determine. 
This  determination  he  only  can  make,  who  hath  al- 
ready erected  his  ideal  standard,  as  now  proposed. 
Otherwise,  he  cannot  but  frequently  err  in  his  diag- 
nosis. But  he  who  hath  ever  at  hand  in  his  scientific 
store,  a  perfect  ideal  of  the  healthy  organs,  shall 
scarcely  err,  since,  in  every  diagnostication,  he  will 
strictly  compare  the  real  with  the  perfect  ideal,  or 
standard,  and,  from  observing  the  deviations  and  aber- 
rations, deduce  a  perfect  knowledge  of  the  case  before 
him. 

In  order  to  raise  up  such  an  ideal  or  standard  of  the 
uterus,  it  is  necessary  to  analyze  its  component  tex- 
tures, and  arrange  them ;  for  example,  into  a  series,  as  : 
1.  The  serous  tissue.  2.  The  mucous  tissue.  3.  The 
sanguiferous;  4,  absorbent;  5,  the  muscular  tissue.  C. 
The  Nervous  substance.  7.  The  glandules  and  folli- 
cles.    8.  The  areolar  texture. 

These  are  the  only  things  in  the  uterus  that  can  be 


OF  THE  NECK  OF  THE  UTERUS.        27 

subjects  of  disease,  whether  severally  or  conjointly. 
When  they  are  combined  in  the  just  ratio  of  mass 
crasis  and  vital  force,  they  represent  the  form  and 
substance  of  the  healthy  womb,  and,  we  might  add,  its 
faculties  also;  whereas,  every  deviation  from  such 
normal  ratio  of  the  elementary  tissues,  represents  a 
certain  disease  of  that  organ. 

Equable  augmentation  of  the  elementary  tissues  con- 
stitutes hypertrophy  of  the  uterus — which  may  be 
either  local  or  general. 

Hypertrophy  of  the  womb  may  be  physiological  or 
pathological. 

The  term  physiological  hypertrophy  here  applies  to 
those  equable  augmentations  of  the  elements  of  the 
uterus,  that  take  place  in  pregnancy,  in  which  the 
womb  acquires,  in  the  course  of  280  days,  a  greatly 
increased  volume,  and  a  weight  of  25  to  30  ounces.  In 
the  non-gravid  state,  its  length  is  about  2i  inches :  in 
pregnancy,  it  is  12  inches  in  length.  The  non-gravid 
weight  is  2  J  ounces,  whereas  it,  not  rarely,  weighs  two 
pounds,  at  term.  These  great  changes  occurring  in  the 
mass,  while  inconsiderable  changes  in  the  ratio  of  its 
elements  take  place,  can  only  be  the  result  of  a  physio- 
logical hypertrophization — and  it  is  well  to  make  such 
a  reflection,  seeing  that  the  womb  recovers  its  non-gravid 
form,  substance,  and  faculties,  in  about  thirty  days  after 
the  termination  of  pregnancy. 

In  this  process  of  Normal-hypertrophy,  the  several 
elementary  textures  are  evolved  in  their  equal  gene- 
rical  ratios ;  and  the  same  kind  of  equable  development 


28  ACUTE   AND    CHRONIC    DISEASES 

takes  place  in  all  the  cases  of  true  pathological  hyper- 
trophy. 

As  the  womb  readily  recovers  from  any  physiological 
hypertrophy  in  about  thirty  days  after  the  removal  of 
the  cause,  so,  in  like  manner,  it  recovers  from  its  patho- 
logical hypertrophy  soon  after  the  removal  of  its  cause. 
Such  cause  may  be  a  polypus  developed  within  the 
cavity  ;  chronic  inflammation  of  the  cervix  or  os  uteri ; 
dislocated  states  of  the  uterus,  in  retroversion,  or  ante- 
version  ;  or  any  circumstance  that  should  provoke  the 
organ  to  grow  inordinately,  but  equably,  as  to  the  ratio 
of  its  elements. 

Unequable  development  of  the  several  elements, 
converts  the  womb  into  a  Tumor,  degenerates  it,  and 
renders  it  incurable  by  medicines ;  whereas,  the  state 
of  pathological  hypertrophy  is  one  to  be  recovered  from 
upon  removal  of  the  cause. 

If,  in  a  womb,  the  areolar  or  the  vascular,  or  the 
nervous  element,  should  be  augmented  several  hundred 
per  cent,  beyond  its  normal  ratio,  the  rest  of  the  tissues 
preserving  their  quantitative  relations  to  each  other, 
the  viscus  would  be  changed  into  a  hematoma,  a  ce- 
phaloma,  &c.  &c,  according  to  the  nature  of  the  case  or 
chief  constituent  element  of  such  tumor. 

Unhappily,  the  womb  is,  by  nature,  peculiarly  sub- 
ject to  such  changes.  It  may  pass  unharmed  through 
the  hypertrophizations  and  recoveries  of  many  conse- 
cutive pregnancies,  because  of  its  innate  aptitude  to 
recover  its  non-gravid  form  and  substance  by  involution 
as  the  antithesis  of  its  acts  of  evolution ;  a  reflection 


OF  THE  NECK  OF  THE  UTERUS.        29 

this  that  affords  us  the  greatest  encouragement  when 
called  on  to  undertake  the  treatment  of  cases  of  en- 
larged womb.  So  true  is  this,  that,  in  all  cases  where 
we  can  clearly  diagnosticate  a  uterine  hypertrophy,  we 
may  found  on  it  a  happy  prognosis,  provided  we  may 
also  reasonably  expect  to  remove  the  cause  of  the  ex- 
cessive growth,  e.  g.  if  the  cause  should  prove  to  be  a 
mere  retroversion,  we  may  count  upon  a  cure  if  we  can 
reposit  the  womb  and  maintain  it  in  its  proper  attitude 
in  the  pelvis.  This  is,  in  fact,  all  that  we  shall  be 
called  upon  to  do;  for,  this  being  done,  the  organ 
hastens  to  recover  by  involution  its  non-gravid  form 
and  substance,  as  after  a  delivery  at  term,  or  after  an 
abortion. 

A  perfect  ideal  of  the  normal  womb,  one  fit  to  serve 
as  a  standard,  or  scale  of  comparison  or  measurement 
for  cases,  should  comprise,  in  addition  to  a  notion  of  its 
elements,  one  of  its  form,  volume,  place,  posture  in  that 
place,  sensibility,  resistance,  complexion,  and  all  its 
powers  as  well  as  its  anatomical  relations  or  connec- 
tions. 

A  great  help  to  the  formation  of  this  ideal  standard, 
may  be  found  in  drawings  and  engravings.  And  here 
we  beg  leave  to  submit  a  figure  (Fig.  1)  copied  from 
nature.  The  womb,  which  was  that  of  a  young  un- 
married woman,  was  2 \  inches  in  length,  by  If  in 
width  at  the  widest  part.  Its  weight  might  be  2  h 
ounces.  The  specimen,  a  recent  one,  was  presented  to 
us  by  Dr.  Addinell  Hewson,  of  Philadelphia.  "We  re- 
gard this  uterus  as  a  fair  standard  specimen. 


30  ACUTE    AND    CHRONIC    DISEASES 

In  respect  to  this  drawing,  and  indeed  all  the  figures 
made  use  of  as  illustrating  points  treated  of  in  this 
essay,  we  owe  an  apology  for  their  want  of  artistic 
excellence.  It  is  clearly  out  of  the  question  that  we 
should  show  these  things  to  artists,  as  well  as  that 
no  artist  could  represent  them  from  mere  description. 
We  did  try  that  experiment,  which  failed.  We  were 
then  compelled  to  become  artists  in  self-defence,  and  suc- 
ceeded, as  is  here  to  be  seen,  in  making  very  inelegant, 
but  very  faithful  representations  of  the  subjects  of  the 
sketches.  As  to  their  fidelitj'  we  have  no  other  assur- 
ance to  give  than  such  as  we  may  refer  to  as  profes- 
sional experience ;  and  we  feel  assured  that  all  those 
physicians  who  have  been  obliged  to  acquire  this  pain- 
ful experience  must  concur  in  the  opinion  that  our 
drawings  are  very  truthful. 

This  figure,  it  is  therefore  believed,  gives  a  fair  ave- 
rage representation  of  the  form  and  size  of  the  human 
womb.  The  chirurgical  neck  projects  within  the  re- 
mains of  the  vagina,  to  the  normal  depth ;  and  the 
aperture,  or  os  uteri,  preserves  its  appearance  as  a 
transverse  sulcus. 

Fig.  2  represents  an  antero-posterior  section,  and  ex- 
hibits the  left  symmetrical  half  of  the  womb ;  showing 
the  thickness  of  the  walls,  in  this  direction ;  the  size 
and  shape  of  the  cavity ;  as  well  as  those  of  the  canal 
of  the  neck ;  the  two  lips,  anterior  and  posterior ;  and 
the  length  of  the  vaginal  neck  or  surgical  neck. 

Fig.  3  is  a  transverse  section  of  the  womb,  exhibiting 
the   posterior   half,    with   the    shape    and   size   of   the 


OF  THE  NECK  OF  THE  UTERUS.        31 

cavity;  as  well  as  the  canal  of  the  cervix,  and  the 
orifice  as  seen  in  this  way. 

Fig.  4  is  designed  to  give  an  idea  of  the  womb's  place 
and  position  or  attitude  in  the  pelvis.  It  is  on  a  scale 
of  half  an  inch  to  the  inch ;  and  shows  how  far  below 
the  plane  of  the  superior  strait  (see  dotted  line)  the 
fundus  uteri  should  be  found. 

Most  of  the  published  drawings  have  erroneously 
exhibited  the  fundus  uteri  rising  as  high  as  the  plane 
of  the  strait,  or  even  elevated  somewhat  above  it,  which 
is  incorrect,  and  leads  to  considerable  errors  in  diag- 
nosis. 

Considering  that  the  plane  of  the  ischium  is  oh  inches 
long,  and  that  the  mean  length  of  a  normal  womb  is 
about  21  inches,  the  figure  may  serve  to  give  a  correct 
idea  of  standard  as  to  place  and  altitude,  since  the 
diagnosticator,  by  touching  the  os  tincaB,  at  once  recog- 
nizes the  place  in  the  excavation  where  it  is  found,  as 
whether  too  high,  or  too  low,  and  he  also  determines, 
by  palpation  at  the  hypogastrium,  whether  the  fundus 
is  too  much  elevated  or  no ;  and  so  he  judges  of  the 
length  and  volume  of  the  womb  he  is  examining. 

The  anatomical  relations  of  the  womb  are  those  which 
unite  it  with  the  bladder  in  front ;  the  vagina  inferior- 
ly;  the  broad  and  the  round  ligaments,  ovaries,  and 
Fallopian  tubes  at  the  sides  and  angles;  while,  poste- 
riorly, it  has  no  anatomical  relations  whatever;  that 
surface  being  there  completely  invested  with  a  peri- 
toneal covering. 

The  standard  should  comprise  a  true  idea  of  the  os 


32  ACUTE   AND   CHRONIC    DISEASES 

tincse  or  aperture  of  the  canal,  many  deviations  from 
the  standard  being  observable  in  practice ;  all  of  which 
may  afford  useful  lights  in  diagnosis,  prognosis,  and 
practice :  certain  changes  of  its  form  may  be  regarded 
as  pathognomonic. 

The  sensibility  of  the  uterus  to  pressure  or  contact ; 
its  resistance  and  flexibility,  ought  also  to  form  part  of 
the  ideal  ;  and  lastly,  the  color  or  tint — as  observed  in 
the  metroscope — as  whether  pale,  rose-tinted,  raspberry- 
red,  violaceous;  or  even  of  a  hue  approaching  to  that 
of  melanotic  tissues,  constitutes  an  important  item  in 
the  aggregate  of  characteristics. 


Experience  has  shown  that  many  instances  of  bad 
health  are  to  be  attributed  to  acute  or  chronic  ailments 
of  the  womb,  in  women,  where  no  topical  pain  or  other 
sign  of  local  lesion  is  complained  of. 

Thus  some  of  the  examples  of  perverted  innervation 
exhibited  in  torpor  of  the  bowels,  chronic  tympanitis, 
frequent  attacks  of  spasm,  and  general  convulsion ;  ce- 
phalalgia, palpitation  of  the  heart,  pain  in  the  back 
loins  and  lower  extremities ;  fluor  albus,  and  aggravated 
hydrsemia,  take  their  origin  from  disease  of  the  cervix 
uteri,  which,  meanwhile,  gives  no  pain,  and  is  wholly  un- 
suspected as  the  subject  of  any  disease.  In  so  far,  there- 
fore, as  these  affections  spring  from  acute  and  chronic 
disease  of  the  neck  of  the  uterus,  they  might  be  assumed 
to  come  within  the  scope  of  inquiries  assigned  to  this 
essay ;  but  since  an  elaborate  statement  of  all  those  sub- 


OF  THE  NECK  OF  THE  UTERUS.        66 

jects  would  fill  a  volume  rather  than  this  essay,  we  shall 
confine  our  remarks  within  narrower  limits. 

Among  the  number  of  sexual  disorders,  few  are  more 
frequently  complained  of  than  leucorrhoea,  and  it  seems 
probable  that  most  women  have  occasion,  at  some  period 
of  life,  to  complain  of  it.  In  general,  it  gives  little  in- 
convenience, is  of  short  duration,  and  ceases  sponta- 
neously; not  requiring  for  its  cure  the  advice  of  physi- 
cians. Perhaps  in  a  thousand  cases  of  moderate  fluor 
albus,  the  physician  would  be  consulted  for  one  or  two 
only.  This,  however,  is  not  the  case  always,  for  in  cer- 
tain exceptions  the  secretion  becomes  very  great,  and  is 
attended  with  debility,  pain  in  the  back  and  loins,  a 
sense  of  bearing  down  or  weight  in  the  pelvis,  with  heat 
in  the  passages,  which  may  pass  into  insufferable  pruri- 
tus. Instances  in  which  the  profluvium  is  very  great, 
will  rarely  be  met  with  in  any  physician's  practice ;  and 
not  many  of  the  subjects  are  found  to  require  the  use  of 
the  guard-napkin,  a  precaution  which  could  not  be  dis- 
pensed with  if  the  secretion  were  so  abundant  as  is  by 
some  supposed.  We  have  heard  of  cases  of  leucorrhoeal 
discharge  to  the  amount  of  eight  ounces  per  day,  but 
probably  such  examples  occur  not  more  than  once  or 
twice  in  a  long  career  of  medical  practice ;  one  in  Avhich 
the  secretion  should  equal  a  tablespoonful  per  day, 
even,  would  be  very  troublesome,  as  well  as  uncommon, 
the  majority  of  the  patients  complaining  only  of  an  in- 
convenient humidity  of  the  parts. 

Where  the  discharge  in  leucorrhoea  consists  of  merely 
vaginal  products,  it  may  safely  be  assumed   that  such 


34  ACUTE    AND   CHRONIC    DISEASES 

leucorrhoea  is  of  very  little  consequence  to  the  woman's 
general  health.  We  speak  here  of  the  moderate  cases. 
Indeed,  affections  of  the  vagina  may,  for  the  most  part, 
be  considered  to  interest  very  little  the  female  constitu- 
tion. 

Such  a  statement  as  this  might  excite  surprise,  in 
those  who  are  accustomed  to  hear  of  the  very  debilitat- 
ing effects  of  fluor  albus ;  and  it  becomes  necessary  to 
qualify  the  statement,  by  showing  that,  in  those  cases 
where  the  health  has  appeared  greatly  to  suffer,  the 
essential  malady  is  not  in  the  vagina,  but  in  the  neck 
of  the  uterus  itself. 

Patients  do  not,  in  general,  make  any  discrimination 
between  the  several  different  appearances  presented  in 
fluor  albus ;  because  they  are  satisfied  to  believe  that 
excessive  humidity  of  the  genital  mucous  surface  is 
fluor  albus,  or  vaginal  leucorrhoea,  a  disorder  whose  pre- 
sence disturbs  them,  not  only  by  the  actual  inconveni- 
ence occasioned  by  it,  but  in  a  more  considerable  degree 
by  the  apprehension  it  arouses  of  prospective  mischiefs 
to  their  health. 

While  our  own  observation  convinces  us  that  profuse 
vaginal  secretion  is  rarely  met  with  in  practice,  we  are 
equally  convinced  that  some  of  the  patients  are  rendered 
too  moist  by  excessive  activity  of  Duverney's  glands, 
and  farther,  that  the  most  mischievous  of  leucorrhceal 
secretions  is  that  which  comes  from  the  canal  of  the 
cervix  of  the  womb. 

The  muciparous  glands  of  the  vagina  furnish  either  a 
thin  watery  mucus,  or  else  one  of  a  creamy  consistence, 


OF  THE  NECK  OF  THE  UTERUS.        35 

which  in  other  instances  appears  to  be  butyraceous,  or 
concrete. 

The  excretion  from  the  follicles  and  glands  of  the  canal 
of  the  neck,  however,  is  always  gluey  or  albuminous,  and 
resembles  fresh  white  of  eggs ;  and,  when  the  patient,  in 
describing  the  disorder,  informs  us  that  she  discovers  a 
slimy  transparent  mucus,  and  especially  if  it  appears  at 
intervals  of  once  a  day,  or  oftener,  we  may  take  it  for 
granted  that  she  labors  under  inflammation  of  the  neck 
of  the  womb.  There  is  no  apparatus  in  the  vagina 
itself  for  the  secretion  of  this  albumen ;  but  the  abun- 
dant follicles  of  the  canal  of  the  cervix  are  devoted 
solely  to  such  production — when  the  cervix  is  chroni- 
cally inflamed,  that  production  is  much  increased  ;  to 
that  degree,  indeed,  as  to  impart  a  character  of  sliminess 
to  the  discharge,  that  makes  it  resemble  albumen  ovi 

It  very  often  happens  to  observe  this  transparent  vis- 
cid mucus  to  be  wholly  unaccompanied  by  any  vaginal 
excretion;  the  substance  coming  away  from  the  os  uteri, 
and  escaping  upon  the  napkins  without  the  least  admix- 
ture. In  using  the  metroscope,  the  same  albuminous 
matter  may  be  seen  oozing  forth  from  the  orifice  of  the 
womb  only,  and  so  tenacious  that  it  cannot  be  wiped 
away  with  the  sponge. 

Those  physicians  who  have  attended  women  in  la- 
bor, are  familiar  with  the  viscous  excretion  from  the 
neck  of  the  womb,  which  generally  discharges  consider- 
able quantities  of  it  while  the  os  is  undergoing  dilatation. 
In  a  state  of  ordinary  health,  the  production — which  is 
equal  merely  to  the  physiological  demand — is  so  incon- 


36  ACUTE    AND    CHRONIC    DISEASES 

siderable,  that  the  albumen  is  not  to  be  observed  ;  but 
any  augmented  vital  activity  in  the  cervix  may  make 
its  presence  manifest. 

It  has  already  been  remarked  that  subjects  of  leucor- 
rhcea  complain  of  it  as  a  weakening  disorder ;  nor  can 
it  be  denied  that  this  albuminous  fluor  from  the  cervix 
mostly  coincides  with  a  sense  of  great  lassitude  and  de- 
bility— not  because  of  the  wastage  of  the  material,  but 
because  of  the  disturbing  effect  in  the  general  economy, 
produced  by  even  slight  modifications  of  the  health  of 
the  uterus.  Hence  I  may  venture  to  say,  that  those 
women  who  complain  of  the  exhausting  effect  of  their 
leucorrhoea,  should  be  regarded  as  suffering,  not  from 
the  loss  by  secretion,  but  from  the  perturbating  influ- 
ence of  a  chronic  inflammation  of  the  womb. 

Physicians  consulted  for  these  leucorrhceal  affections, 
ought,  therefore,  carefully  to  discriminate  between  the 
different  kinds  of  discharges.  When  the  excretion  is 
deemed  to  proceed  from  the  muciparous  apparatus  of  the 
vagina  only,  it  may  suffice  to  make  astringent  injections, 
whether  of  mineral  or  vegetable  sorts.  In  case  such  re- 
medies prove  unavailing,  the  vital  activity  of  the  mu- 
cous body  may  be  changed  by  solutions  of  argent,  nitrat., 
of  feeble  strength — and  one  might  confidently  look  for  a 
cure  under  such  a  prescription.  Yet,  in  fact,  our  ordi- 
nances for  those  disorders  are  notoriously  unsuccessful ; 
and  the  reason  is,  we  vainly  attempt  by  these  methods 
to  cure  a  disease  of  the  vagina  which  does  not  exist, 
which  would  not  make   the  woman  ill  if  it  really  did 


OF  THE  NECK  OF  THE  UTERUS.        37 

exist ;  whereas  we  ought  to  be  addressing  our  remedies 
to  the  removal  of  a  disease  of  the  cervix. 

We  should  cure  a  much  greater  number  of  leucor- 
rhoeas  if  we  would  not  misinterpret  the  disorder,  call- 
ing that  a  vaginal  which  is  really  a  cervical  malady, 
and  vice  versa. 

We  repeat,  that  the  serious  cases  are  cases  of  disease 
of  the  cervix — but,  a  vaginal  injection  for  inflammation 
of  the  canal  of  the  neck,  is,  simply,  ridiculous.  The 
albuminous  leucorrhcea  is  a  sign  of  inflammation  of  the 
cervix,  in  which  is  included  the  canal,  with  its  copious 
muciparous  apparatus.  It  is  as  much  a  surgical  dis- 
order as  an  ulcer  of  the  leg,  or  an  anthrax,  or  conjuncti- 
vitis. When  the  surgical  disorder  is  cured  the  sign  dis- 
appears. Hence  we  desire  to  express  the  opinion,  that 
such  leucorrhoeas  are  to  be  held  as  acute  or  chronic  in- 
flammations of  the  canal  of  the  neck,  and  ought  to  be 
treated  accordingly. 

The  most  essential  element  of  a  successful  practice 
exists  in  a  positive  diagnosis.  It  will  not  do  for  us  to 
believe,  or  suspect,  or  infer,  this  or  that — we  must  guard 
the  interests  of  the  patient  by  knowing  it  is  this,  or 
that,  or  the  other  form  and  stage  of  a  disease. 

The  historical  or  descriptive  account  delivered  by  the 
patient,  or  her  friends,  cannot  serve  as  a  guide  for  us ; 
nor  can  they  compare  the  actual  state  of  the  suffering 
organ  with  that  perfect  ideal  standard,  by  which  we 
ought  to  compare,  weigh,  and  measure  everything 
brought  before  us  for  judgment. 

It  must  ever  be  a  very  trying  occasion,  that  of  a  sensi- 


38  ACUTE    AND    CHRONIC    DISEASES 

tive  and  delicate  woman,  who  is  brought  into  such  a  strait 
as  to  require  a  physical  examination  of  those  parts 
which  naturally  shun  exposure.  The  medical  man, 
who  has  even  a  common  share  of  sensibility,  will  al- 
ways, therefore,  defer  this  last  resort  as  long  as  possible, 
while  he  makes  use  of  empirical  treatment — if,  haply, 
he  might  thus  be  enabled  to  effect  a  cure  without  the 
waiver,  on  her  part,  of  those  honorable  scruples  which 
deserve  from  him  the  most  perfect  respect. 

Of  all  the  means  of  making  a  physical  diagnosis, 
Touching  is  the  easiest  and  the  least  distressing  to  a 
woman  of  sensibility,  bad  though  it  be.  By  Touching, 
we  can  determine  the  place,  the  volume,  the  resistance, 
the  sensibility,  the  smoothness  or  roughness,  the  patu- 
lousness,  and  other  characteristics  of  the  organ. 

Where  the  touch  gives  sufficient  information,  let  the 
Touch  suffice ;  but,  if  any  doubts  as  to  the  wants  of  the 
case  remain,  then  a  Metroscopic  examination  should  be 
made.  If  declined — let  the  consequences  rest  with  the 
patient ;  the  physician  is  absolved  from  blame. 

There  are  a  great  many  sorts  of  Metroscopes  now  in 
use — some  consisting  of  a  tube,  as  originally  proposed 
by  Recamier,  but  composed  of  glass,  or  silver,  or  ivory, 
&c. ;  and  some  consisting  of  a  bivalve,  trivalve,  or 
quadrivalve  Speculum  uteri,  each  of  which  is  pre- 
ferred, according  to  the  taste  or  caprice  of  the  practi- 
tioner. 

The  most  reliable  metroscope,  probably,  is  a  slightly 
conical  tube  of  silver,  six  inches  and  a  half  in  length. 
The  uterine  extremity  should  be  one  inch  in  diameter, 


OF  THE  NECK  OF  THE  UTERUS.        39 

bevelled  with  an  angle  of  thirty-five  or  forty  degrees. 
The  outer,  or  larger  extremity,  should  be  one  inch  and 
a  half  in  diameter.  The  silver  should  be  highly 
.polished,  with  the  edges  of  the  bevelled  end  rolled  and 
rendered  blunt,  lest  they  might  catch  in  the  folds  of 
the  membrane,  or  even  wound  the  cervix. 

An  olive-shaped  piece  of  wood,  secured  in  a  steel 
handle,  and  made  to  fit  accurately  in  the  smaller  ex- 
tremity of  the  cone,  serves  to  guide  it  without  pain  to 
the  bottom  of  the  vagina,  whereupon  the  guide  is  with- 
drawn, in  order  that  the  Surgical  neck  may  engage  in 
the  opening,  and  thus  enable  the  surgeon  to  discern  any 
marks  of  disease  there. 

The  light  passing  down  the  tube  ought  to  be  as  clear 
as  possible,  and  the-  inner  surface  of  the  metroscope 
should  not  have  a  very  high  polish,  lest,  serving  as  a 
reflector,  it  might  pour  a  flood  of  chromatized  light  on 
the  parts,  and  thus  give  rise  to  the  greatest  misappre- 
hension of  their  real  condition.  It  would  be  better  to 
have  the  inner  surface  painted  with  black,  in  order  that 
no  reflection  from  the  walls  should  deceive  us,  and  lead 
to  error.  Any  person  accustomed  to  the  use  of  the  me- 
troscope with  a  very  bright  inner  surface,  or  bore,  must 
be  familiar  with  the  sparkling  red  points  that  it  seems 
to  disclose  upon  the  mucous  surfaces  exposed  by  it  to 
view,  and  also,  must  have  seen  how  a  slight  change  in 
the  direction  of  the  tube,  causes  these  red  lights  to 
disappear ;  but  they  are  always  apt  to  mislead,  and 
therefore  it  would  be  better  to  use  a  tube  whose  inner 
surface  should  have  no  lustre :  a  tube  blackened  within, 


40  ACUTE    AND    CHRONIC    DISEASES 

like  a  microscope  tube,  would  be  far  better  than  one 
with  a  reflector,  such  as  the  glass  speculum  uteri. 

An  instrument  on  the  plan  above  proposed  can  dis- 
close the  physical  appearances  of  any  square  inch  of  the 
inner  walls  of  the  vagina;  for  by  merely  rotating  the 
tube  on  its  axis,  and  directing  the  bevelled  end  this 
way  or  that,  we  may  at  leisure  observe  any  part  of  the 
cervix  or  vagina. 

The  bivalve  and  the  quadrivalve  speculum  are  some- 
times convenient ;  but  they  as  often  annoy  us  and  ob- 
struct the  research  by  allowing  folds  of  the  vagina  to  fall 
in  between  the  parted  blades,  and  thus  completely  hide 
the  parts  sought  to  be  studied.  They  are  by  no  means 
suitable  for  the  application  of  the  cautery,  whether 
liquid  or  solid ;  and  no  one  could  conveniently  make 
use  of  leeches  by  means  of  them.  In  any  case,  where 
the  multi valve  speculum  is  applicable,  M.  Recamier' s 
tube  is  more  so,  on  which  account,  we  prefer  it  alto- 
gether. 

Plate  4  represents  a  Recamier  metroscope,  with  its 
guide.  This  instrument  is  of  silver,  and  bevelled  in  a 
way  to  facilitate  the  operation,  in  engaging  the  os  tineas 
in  the  open  end  of  the  tube,  which  readily  catches  the 
cervix  by  its  projecting  long  lip.  It  has  not  any 
handle,  a  thing  that,  moreover,  is  both  useless  and 
troublesome  by  catching  in  the  bed-linen  or  the  nap- 
kins with  which  the  patient  is  always  to  be  enveloped 
on  such  occasions. 

With  a  Recamier  tube,  one  can  readily  observe  any, 
even  slight  modifications  of  form  or  surface,  hue,  abra- 


OF  THE  NECK  OF  THE  UTERUS.        41 

sion,  vegetations,  druses  or  botryoiclal  excrescences. 
Small  polypi,  jutting  from  the  canal  of  the  neck,  any 
fissures  or  rhagades,  ulcerations,  cauliflower  degenera- 
tion, or  open  carcinoma,  &c.  &c,  that  shall  have  given 
rise  to  the  symptoms  may  be  thus  seen.  The  same 
occasion  may  be  seized  to  make  such  surgical  dressings 
as  may  be  indicated,  and  the  sacrifice  of  sensibility  in 
this  way  made  by  the  sufferer,  is  almost  sure  to  be  re- 
warded by  a  speedy  cure  of  any  curable  disorder,  which, 
but  for  such  sacrifice,  would  continue  to  make  her  un- 
happy, leading,  by  a  perpetual  progress  of  deterioration, 
to  ruined  health,  and,  finally,  to  the  last  refuge  of  the 
miserable,  which  is  the  tomb. 

A  diagnosis  by  the  metroscope  should  be  made  in  the 
daylight,  and  always  in  presence  of  a  third  person. 

The  patient  should  lie  on  the  back,  near  the  side  or 
foot  of  the  bed  ;  the  head,  and  not  the  shoulders,  rest- 
ing upon  a  pillow.  A  sheet  or  spread  is  to  cover  the 
person ;  the  margin  of  the  covering  to  descend  nearly  to 
the  floor. 

The  knees  should  be  much  flexed,  and  the  feet  near 
to  the  trunk  of  the  body. 

Before  proceeding  to  adjust  the  instrument,  an  exa- 
mination should  be  made  by  Touching,  to  ascertain  the 
precise  position  of  the  uterus,  and  the  place  occupied 
by  the  cervix ;  the  sensibility,  resistance,  volume,  &c. 
of  the  neck,  and  particularly,  the  state  of  the  aperture 
of  the  womb. 

There  should  be  provided  a  Speculum-forceps,  and 
some  small  bits  of  moistened  sponge,  or  carded  cotton, 


42  ACUTE    AND    CHRONIC    DISEASES 

which,  being  held  in  the  forceps,  serve  to  absorb  or 
remove  any  mucus  or  slime,  or  sanguineous  excretion. 
The  most  convenient  Speculum-forceps  that  can  be  got 
is  probably  a  bullet  forceps ;  such  as  the  one  proposed 
by  Professor  Gibson. 

The  Speculum-forceps  of  Charriere  is  far  less  conve- 
nient. 

If  the  Metroscope  should  now  be  adjusted  beneath  the 
coverings,  and  the  margin  of  the  sheet  be  afterwards  care- 
fully wrapped  around  the  outer  end  of  the  cylinder,  it 
will  be  easy  to  conceal,  in  this  way,  the  entire  person  of 
the  patient,  while  the  light  falling  down  the  tube,  serves 
to  reveal  any  existing  signs  of  disease  of  the  parts  to  be 
examined. 

If  these  inquiries  are  instituted  for  the  purpose  of 
determining  the  precise  cause  and  learning  the  proper 
treatment  of  a  troublesome  leucorrhcea,  especially  one 
characterized  by  the  albuminous  discharges  heretofore 
mentioned,  we  shall  rarely  fail  to  observe  a  positive 
inflammation  of  the  cervix  and  os  uteri,  or  to  notice  a 
certain  quantity  of  transparent  viscid  phlegm,  oozing 
slowly  away,  or  tamponing  the  orifice  of  the  canal  of 
the  cervix. 

One  or  both  of  the  lips  of  the  womb  may  be  found 
tumid,  softened,  granulated,  or  botryoidal  in  appear- 
ance, and  of  a  uniform  red ;  or  else  drusy  as  to  the  sur- 
face, and  presenting  some  resemblance  to  the  surface 
and  color  of  a  ripe  raspberry;  whence  it  has  been  the 
custom  of  some  to  speak  of  this  form  of  inflammation  as 
inflammation  framboisee,  a  French  word  that  very  aptly 
expresses  the  idea  of  it. 


OF  THE  NECK  OF  THE  UTERUS.        4d 

Annexed  is  a  drawing  (vide  Plate  5),  by  which  we 
hope  to  impart  a  correct  idea  of  one  of  the  forms  assumed 
in  inflammation  of  the  cervix  uteri.  It  was  drawn 
soon  after  the  inspection  of  a  case  that  was  under  the 
care  of  the  Author.  The  lad}',  about  forty  years  of 
age,  was  the  mother  of  several  children,  of  whom  the 
youngest  was  between  three  and  four  years  old. 

She  had  long  complained  of  weakness,  pain,  and  drag- 
ging sensation  in  the  back  and  loins,  a  bearing  down  at 
the  hypogaster,  and  a  leucorrhoea,  which  she  supposed 
to  be  the  whole  malady.  Her  fastidious  delicacy  in- 
duced her,  for  many  months,  to  conceal  her  uneasiness ; 
nor  did  she  at  last  apply  for  counsel,  until  her  health 
was  very  much  reduced,  and  her  appearance  greatly 
changed.  She  had  acquired  a  deep  sallow  tint  of  the 
skin  ;  had  anorexia  ;  lowness  of  spirits  ;  intestinal  tor- 
por; slight  d^ysuria,  and  a  constant  fluor  albus. 

It  was  not  until  after  presenting  clearly  to  her  com- 
prehension a  statement  of  the  motives  for  it,  that  she 
reluctantly  consented  to  allow  a  metroscopic  examina- 
tion to  be  instituted ;  and  it  manifestly  appears  that 
none  other  could  have  possibly  revealed  the  real  nature 
of  her  position  and  its  danger. 

The  os  tincse  of  a  healthy  woman  with  difficulty  suffers 
the  passage  of  a  small  female  catheter  into  the  canal  of 
the  cervix.  In  this  case,  the  ends  of  two  fingers  could 
be  introduced  nearly  half  an  inch.  The  cervix,  of  course, 
must  be  much  enlarged  to  make  so  great  an  aperture. 
But  the  drawing,  which  is  believed  to  be  as  correct  as 


44  ACUTE    AND    CHRONIC    DISEASES 

any  daguerreotype  could  be,  will  show  better  than  words 
the  appearance  it  presented. 

Plate  5,  which  may  be  compared  with  Plate  1,  will 
show  how  enormously  this  Chirurgical  neck  and  this  os 
uteri  exceed  in  magnitude  the  one  we  have  presented  as 
a  sample  of  the  ideal  or  standard  uterus. 

The  cervix,  although  so  greatly  enlarged,  and  as  red 
as  the  tint  in  the  drawing,  was  not  exceedingly  sensi- 
tive. Its  resistance  was  neither  too  hard  nor  too  soft, 
as  is  the  case  in  the  hypertrophies.  The  os  had  the 
shape  or  form  here  expressed.  It  was  enlarged,  but 
not  deformed.  Had  it  been  deformed,  that  circumstance 
alone  would  decide  as  to  its  being  not  hypertrophy ; 
because,  it  would  prove  that  the  development  or  growth 
was  non-equable. 

The  orifice  or  aperture  of  the  canal  was  occupied  with 
a  viscid  transparent  slime,  which  was  the  albuminous 
product  of  sur-excited  muciparous  glands  and  follicles, 
which  abundantly  line  the  canal  of  the  cervix.  Its  ap- 
pearance is  pretty  well  represented  in  the  engraving. 

Inspecting  the  interior  of  the  canal  of  the  neck,  as 
far  as  it  could  be  observed,  the  red  tint  seen  on  the  lips 
gradually  passed  into  the  dark,  almost  black  hue,  which, 
in  the  figure,  approaches  to  the  color  of  melanotic 
tissues,  and  it  was  of  so  black  a  color  as  to  lead 
the  writer  at  first  to  fear  that  it  was  due  to  some  pro- 
cess of  sloughing.  He  had  never,  in  any  other  case, 
noticed  anything  similar. 

This  case  was  treated,  by  the  author,  by  means  of 
antiphlogistic  contacts   of  the  nitrate   of  silver  pencil. 


OF  THE  NECK  OF  THE  UTERUS.        45 

The  number  of  those  contacts,  which  were  reiterated 
with  intervals  of  from  five  to  seven  days,  did  not  exceed 
six  or  eight,  and  as  the  inflammation  vanished  before 
the  therapeutical  power  of  the  remedy,  the  womb  re- 
turned rapidly  to  its  form  and  dimensions;  just  as  it 
would  do,  if,  being  enlarged  by  gestation,  it  should  be 
set  at  liberty,  by  an  abortion,  to  return  to  its  non-gravid 
condition.  We  shall  shortly  explain  the  meaning  and 
intention  of  the  phraseology  we  have  employed,  as  to 
antiphlogistic  applications  of  the  argent,  nitratum. 

The  ideal  womb  is  two  and  a  quarter  inches  long. 
This  specimen  was  so  much  augmented  in  size  that, 
while  the  os  tincse  was  low  down  in  the  excavation,  the 
fundus  was  distinctly  felt  above  the  plane  of  the  supe- 
rior strait,  being  at  least  one  inch  higher  than  that. 

It  might,  perhaps,  be  a  desirable  thing  to  know,  if 
possible,  why  it  happens  that,  in  certain  cases  of  in- 
flamed cervix,  the  surface  of  the  lips  of  the  womb  should 
be  smooth  or  even,  as  is  seen  in  the  present  specimen ; 
while  in  others,  the  inflamed  superficies  become  uneven, 
or  tuberculated,  or  drusy.  To  show  the  difference 
here  alluded  to,  the  Authcft?  begs  to  ask  attention  to 
the  annexed  figure  (Plate  6),  which  exhibits  the  uneven 
surface  in  question. 

This  drawing  is  also  copied  from  nature,  and  repre- 
sents an  appearance  very  commonly  met  with  in  prac- 
tice. The  Chirurgical  neck  is  manifestly  and  much 
enlarged,  which  does  not  imply  merely  swelling  of  the 
texture,  but  rather,  a  condition  of  hypertrophic  growth 
or  nutritive  development.     Here,  as  in  almost  all  the 


46  ACUTE    AND    CHRONIC    DISEASES 

examples,  the  hypertrophy  proceeds  from  the  provoca- 
tion contained  in  a  positively  inflamed  state  of  the 
corpus  mucosum  uteri. 

Such  an  inflammation  is,  virtually,  an  advanced  vital 
■status,  which  stimulates  the  whole  organ,  and  compels 
it  to  obey  its  natural  law,  which  is  that  it  shall  wax  or 
increase  in  substance,  equably  under  certain  stimulation. 
This  is  the  power  which  enables  it  to  go  through  those 
vast  but  equable  mutations  of  its  form  and  substance 
that  coincide  with  gestations. 

One  might  well,  from  inspection  of  such  a  specimen, 
deem  that  the  vital  status  of  the  corpus  mucosum  must 
be  dangerously  exalted.  It  exhibits  many  tubercular 
elevations,  which,  however,  are  soft  and  velvety  to  the 
touch.  There  was  no  ulceration ;  on  the  contrary,  the 
entire  surface  was  covered  with  its  pavemented  epithe- 
lium, which  was  so  delicate,  however,  as  easily  to  be 
broken  by  a  sponge,  or  by  imprudent,  awkward  mani- 
pulation with  the  tube.  Madame  Boivin  seems  to  have 
conceived  the  idea  that  a  tuberculated  surface  like  this 
may  possibly  be  the  expression  of  a  commencing  stage 
of  cauliflower  degeneration,  and  the  thought  is  worthy  of 
attention. 

The  patient  from  whom  this  drawing  was  taken,  was 
rapidly  cured,  the  irregularities  of  the  surface  subsiding 
to  the  ordinary  smooth  level,  and  all  the  excess  of  mag- 
nitude, sensibility,  and  color  of  the  parts  being  taken 
away,  chiefly  by  contacts  of  the  nitrate  crayon — in 
which  surely  resides  a  true  antiphlogistic  therapeutical 


OF  THE  NECK  OF  THE  UTERUS.        47 

force,  as  we  shall  hereafter  endeavor  to  show  and  ex- 
plain at  greater  length. 

Out  of  a  considerable  number  of  drawings,  faithfully 
representing  this  appearance  of  disease  in  the  subject,  I 
have  selected  these  two  as  sufficient  to  explain  or  illus- 
trate those  physical  lesions  the  practitioner  may  expect 
to  meet  with;  not  wishing  to  load  this  essay  with  a  use- 
less array  of  specimens.  I  shall,  however,  add  one 
more  of  this  class  (Plate  7),  taken  from  nature,  in  a 
patient  who  had,  for  a  long  time,  and  in  vain,  been  sub- 
jected to  treatment  by  nitrate  of  silver  cauterizations. 
It  also  presented  the  appearance,  like  that  shown  in 
Plate  5,  of  a  collection  of  albuminous  mucus  in  the 
orifice.  As  here,  so  it  often  happens  to  observe  this 
mucus-production  to  be  greatly  augmented;  whereas,  in 
other  samples  closely  resembling  it  in  certain  patients, 
this  peculiar  sign  is  either  not  seen  at  all,  or  in  indif- 
ferent quantity. 

It  may  well  be  supposed  that  variable  degrees  of  vital 
excitement  in  the  muciparous  apparatus,  might,  for  one 
individual,  or  now,  cause  excessive  production,  while  at 
another  time,  or  in  another  case,  it  should  give  rise  to 
no  excess  in  the  albuminous  production,  and  thus  we 
may  justly  infer  that  this  albuminous  discharge  is  not 
invariably  present  as  a  pathognomonic  characteristic ; 
but  on  the  contrary,  the  inflammation  is  the  thing  to  be 
considered,  treated,  and  cured,  if  we  would  really  restore 
the  patient's  health.  When  the  albuminous  discharge 
is  seen,  it  is,  however,  always  pathognomonic  of  the 
cervical  inflammation. 


48  ACUTE    AND    CHRONIC    DISEASES 

The  Author  respectfully  submits,  that  these  illustra- 
tions are  sufficient  to  confirm  his  assertion,  precedently 
made,  that  diagnostication  by  M.  Recamier's  method  is 
indispensable  for  the  correct  information  of  the  medical 
attendant.  Not  only  do  they  show  how  concise  and 
absolute  such  a  diagnosis  may  be;  but  they  must  con- 
vince that  diagnosis,  by  touching  alone,  could  not  convey 
to  the  mind  so  precise  a  notion  of  the  surgical  and  medi- 
cal wants  of  the  sufferer ;  while  they,  farther,  manifest 
the  facility,  convenience,  and  exactitude,  with  which 
surgical  dressings  and  other  treatment  may  be  made  by 
the  metroscopic  method. 

Whosoever  should  examine  these  illustrations  might 
be  expected  confidently  to  infer  that  so  considerable  an 
inflammation  as  either  of  them  represents,  would  be 
likely,  not  only  to  give  rise  to  the  constitutional  dis- 
orders attendant  upon  many  examples  of  leucorrhoea; 
but  he  would  also  understand  why,  along  with  the 
albuminous  fluor,  there  might  arise  an  excessive  vaginal 
secretion,  which,  nevertheless,  would  be  but  one  of  the 
accidents  of  the  principal  case. 

Daily  experience  convinces  that  multitudes  of  sick 
women  are  treated  by  professional  and  other  persons, 
for  affections  like  those  here  portrayed  (without  the 
least  inkling  of  the  truth),  with  vaginal  injections  of 
various  astringent  and  other  solutions  and  infusions, 
which  rarely  produce  any  good  effect  upon  the  health; 
though  they  serve,  in  many,  to  add  to  the  mischief. 

It  would  certainly  be  a  considerable  step  in  the  pro- 
gress of  clinical  medicine,  were  it  possible  to  clear  up 


OF  THE  NECK  OF  THE  UTERUS.        49 

these  obscurities,  and  banish  from  the  art  the  mere 
senilities  which  so  much  discredit  it;  but  this  can  only 
be  done  by  means  of  perfect  diagnostications. 

I  beg  to  repeat  that  physicians,  in  order  that  they 
may  make  proper  ministrations,  require — not  belief,  but 
knowledge  of  their  cases.  Where  perfect  knowledge 
of  the  case  can  be  obtained,  there  will  be  the  most  perfect 
administration;  there  will  be,  at  least,  the  meliorations; 
and,  in  so  far  as  remedies  can  succeed,  there  will  be  the 
most  successful  results  or  cures. 

A  medical  man,  ordering  injections  for  such  disorders 
as  are  here  described,  will  assuredly  be  baffled,  since  no 
such  injections  can  be  supposed  to  pass  bej'ond  the 
limits  of  the  vagina  itself.  They  cannot  penetrate  into 
the  canal  of  the  cervix.  They  bedew  only  the  mam- 
millary  part  of  the  uterus,  while  they  bathe  the  entire 
of  the  vaginal  walls.  It  is  the  custom  of  many  prac- 
titioners, to  order  vaginal  injections,  composed  of  solu- 
tions of  argent,  nitrat.  of  various  strength.  Few  of 
them,  we  are  persuaded,  can  say  they  have  found 
much  advantage  to  the  patients  from  this  operation.  If 
the  Author  is  to  be  justified  in  asserting  that  the 
major  part  of  these  cases  consist,  essentially,  in  disease 
of  the  cervix  itself,  and  not  of  the  vagina,  which  is  only 
secondarily  or  symptomatically  involved  in  the  dis- 
order— then  such  a  practice  is  either  useless  or  perni- 
cious. If  such  a  solution  is  strong  enough,  it  is  too 
strong;  and  if  it  be  too  dilute,  it  is  indifferent  in  the 
treatment,  or  merely  nugatory. 

The  patient    requires   a   remedy  for  the    raspberry- 
4 


50  ACUTE   AND   CHRONIC    DISEASES 

colored  inflammation  of  the  neck — one  fitted  to  bring  to 

* 

its  close  a  train  of  perverted  and  exalted  vital  force  of  an 
organ,  whose  disturbance  proves  to  be  one  of  the  most 
considerable  disturbers  of  the  constitutional  health. 
The  cure  of  the  real  disease,  the  radiating  point  of 
disturbance,  cures  the  leucorrhoea,  as  well  as  all  the 
balance  of  the  perversions. 

But,  it  is  proper  for  us  to  exhibit  other  appearances 
assumed  by  the  inflamed  cervix  uteri,  lest  a  false  direc- 
tion be  given  to  opinions  upon  such  special  cases  as 
may  come  up  in  one's  practice.  We  have  already  ex- 
hibited several  modifications  of  the  cervical  surfaces 
observed  in  different  specimens,  and  we  here  call  atten- 
tion to  one  represented  in  the  annexed  figure  (Plate  8, 
Fig.  1),  one  that  is  not  quite  so  common  as  the  inflam- 
mation framboisee,  yet  so  common  as  to  be  often  met 
with  in  practice. 

The  appearances  here  exhibited  (Plate  8,  Fig.  1) 
were  those  observed  in  the  case  of  a  lady  from  a  distant 
city,  who  was  addressed  for  treatment,  to  the  writer, 
by  a  distinguished  member  of  the  Profession.  She 
had  been  for  a  considerable  time  under  his  own  medical 
care,  after  having  undergone  a  great  variety  of  surgical 
and  medical  treatment  by  others,  but  without  any  use- 
ful effect. 

She  complained  of  pain  in  the  interior  of  the  pelvis  ; 
and  of  disordered  menstruation,  which  was  both  menor- 
rhagic  and  painful,  as  well  as  irregular  in  its  returns. 
She  had  dysuria;  pain  in  the  middle  of  the  sacrum, 
and  tenesmus :  she  was  excessively  hydrsemical  and  de- 


OF  THE  NECK  OF  THE  UTERUS.        51 

sponding,  and  had  capricious  appetite;  while  acidity 
and  torpid  bowels  accompanied  the  affections  above 
enumerated,  and,  to  crown  all  the  rest,  she  was  fre- 
quently attacked  with  what  might  be  called  crispations, 
or  rather  spasms  and  convulsions,  simulating  closely 
certain  epileptic  forms.  The  nervous  system  was  in  a 
state  of  such  sur-excitement,  that  a  word,  a  look,  an 
emotion,  or  any  motion  of  the  limbs,  often  served  to 
render  her  quite  insensible  from  an  attack  resembling  a 
slight  form  of  puerperal  eclampsia. 

She  had  borne  three  children,  of  whom  she  had, 
within  a  year,  lost  two  by  scarlet  fever;  and  that 
event,  by  the  moral  shock  it  occasioned,  had  greatly 
aggravated  all  her  pre-existing  complaints. 

The  womb  was  retroverted;  the  fundus  resting  in 
the  Douglass  cul-de-sac,  while  the  os  was  near  to  the 
symphysis  pubis. 

Upon  exposing  the  chirurgical  neck  to  a  beam  of  day- 
light, by  means  of  the  Eecamier  tube,  the  os  proved  to 
be  inflamed,  with  the  margin  of  the  anterior  lip  tinted 
red,  just  as  is  here  shown;  while  the  lower  lip  was 
covered  by  a  disk  of  inflamed  corpus  mucosum,  of  a 
square  shape  ;  the  whole  of  this  square  patch  was  evi- 
dently a  raised  surface.  One  might  almost  venture  to 
call  it  a  molluscum  on  the  cervix.  It  is  frequently  met 
with  in  clinical  practice  in  sexual  disorders ;  and  we 
think  always  exhibits  this  peculiar  character.  Its 
frequency  in  practice,  we  repeat,  is  considerable. 

In  reasoning  upon  such  a  case,  it  would  seem  super- 
fluous to  look  beyond  facts,  like  these  as  here   stated, 


52  ACUTE    AND    CHRONIC    DISEASES 

for  a  rationale  of  the  constitutional  and  local  pheno- 
mena. The  healthiest  young  married  woman  is  liable, 
almost  immediately  after  conception,  to  be  affected  by 
those  disturbing  radiations  of  the  uterine  or  hysteric 
force  that  are  developed  by  the  new  vital  states  of 
pregnancy,  and  she  may  soon  be  seized  with  distressing 
nausea,  or  frequent  vomiting,  or  profuse  salivation;  with 
anorexia,  hydrasmia,  hysterical  passion,  and  a  thousand 
perversions  both  of  the  reason  and  the  senses,  as  well 
as  of  the  organic  functions. 

If  the  hysteric  malady,  with  its  incoherent  train  of 
vital  manifestations,  may  arise  out  of  a  basis  of  repro- 
ductive irritation,  even  less  considerable  than  that  of  an 
incipient  gestation;  we  really  are  not  called  upon  to 
look  farther  for  causes  of  the  constitutional  symptoms  of 
our  case  than  to  those  morbid  states  of  the  womb  that 
are  here  set  forth  in  the  figure  9. 

As  to  the  treatment,  the  fundus  uteri  was  lifted  up 
out  of  its  false  position,  the  cervix  was  thrust  back  to  its 
place  near  the  sacrum  (see  the  ideal  standard,  Plate  3), 
and  retained  in  it  by  means  of  an  annular  pessary, 
whose  sacral  segment  rested  in  the  posterior  vaginal 
cul-de-sac,  and  its  pubal  segment  against  the  pubis. 
Nothing  could  now  retro  vert  it  again. 

To  take  the  womb  thus  out  of  its  dislocated  position 
would,  alone,  go  far  towards  insuring  its  recovery;  and 
it  will  be  presently  contended  that  many  of  the  uterine 
diseases,  even  great  hypertrophies,  require  no  farther 
treatment;  but  being  thus  delivered  over  again  under 
dominion  of  their  natural  or  generical  laws,  they  hasten 


OF  THE  NECK  OF  THE  UTERUS.        53 

to  recover  their  true  generic  substance  and  form,  by  in- 
volution, as  after  parturition.  In  this  instance,  however, 
the  disk  of  inflamed  tissue  was  treated  by  antiphlogistic 
contacts  of  argent,  nitrat.,  by  which  it  was  cured;  and 
thus  provision  was  made  for  the  early  removal  of  a 
cause  of  the  constitutional  disorders,  additional  to  the 
displacement  cause. 

Having  repeatedly  spoken  of  contacts  of  the  nitrate  of 
silver  as  antiphlogistic  contacts,  it  seems  proper  now  to 
explain  my  meaning  in  the  use  of  that  phraseology. 

It  is  undeniable  that  a  pencil  of  nitrate  of  silver  ap- 
plied  to  a  soft,  moist,  living  tissue,  and  held  long  in 
contact  with  it,  will  disorganize  the  tissue,  and  so  prove 
to  be  a  destructive  contact.  It  is  equally  undeniable 
that  a  contact  may  be  effected  with  such  rapidity  and 
lightness  as  to  prove  ineffective  or  indifferent,  while 
there  is  another  mode  or  force  which  does  resolve  in- 
flammation with  great  certainty;  and  this  is  the  anti- 
phlogistic contact  above  spoken  of.  "We  therefore  feel 
warranted  to  speak  of  such  use  of  the  nitrate  of  silver 
as  being  either  destructive,  or  indifferent,  or  antiphlo- 
gistic contacts;  and  experience  confirms  the  propriety  of 
the  classification;  for,  we  meet  with  numerous  examples 
of  treatment  that  conclusively  prove  it  is  not  the  mere 
treatment  by  escharotics  that  is  successful,  but  the  use 
of  them  in  such  a  way  as  to  provide  for  their  due  opera- 
tion as  antiphlogistics  and  not  as  destructives ;  for  as 
any  ulceration  of  the  mouth  of  the  womb  is  a  thing  of 
very  rare  occurrence,  we  do  not  require,  in  the  case, 
the  use   of  destructive   contacts  of  the   salt  of  silver 


54  ACUTE    AND    CHRONIC    DISEASES 

or  other  escharotic,  but  only  their  curative  or  antiphlo- 
gistic power — a  power  which  is  perhaps  really  due  to 
their  contro-stimulant  faculty.  Certain  women,  who 
are  in  vain  treated  for  these  cervix-inflammations,  for 
months  in  succession,  by  contacts  of  nitrate  of  silver, 
recover  their  health  very  speedily  upon  a  few  such  an- 
tiphlogistic or  contro-stimulant  touches,  lightly  made — 
that  is,  made  with  due  regard  to  the  resolvent  or  an- 
tiphlogistic power  of  the  drug.  It  is  not  enough,  there- 
fore, in  studying  this  subject,  for  the  practitioner  to 
resolve  upon  the  treatment  by  a  method  of  escharotics 
or  cauterizations,  as  it  is  erroneously  expressed.  Far 
from  it — what  he  requires  is,  to  create  for  himself  an 
ideal  of  his  operation,  so  that,  when  about  to  perform 
it,  he  may  predetermine  what  it  is  he  hath  to  do,  and 
whether  the  contact  he  is  going  to  make  shall  be  a  de- 
structive or  an  antiphlogistic  one.  It  might 
equally  well  be  called  a  resolvent  one.  He  who  fails 
to  set  up  before  him  this  ideal  of  his  duty  and  pur- 
pose, will  be  apt  to  fail  in  the  cure;  or  his  cure  will 
be  a  chance-medley  and  not  the  product  of  a  rightly 
reasoned  purpose  and  conformable  act. 

This  absence  of  precision  in  the  design  and  act  fre- 
quently occasions  the  greatest  and  most  dangerous 
aggravations,  and  the  most  poignant  sufferings — which, 
in  our  estimation,  is  wicked  and  abominable.  They  are 
disgraceful  to  the  Art  and  the  artist  at  once. 

Believing  these  remarks  to  be  both  just  and  clinically 
important,  it  is  desirable  they  should  arrest  the  atten- 
tion of  every  practitioner  in  this  line. 


OF  THE  NECK  OF  THE  UTERUS.        55 

After  the  foregoing  observations,  we  will  now  aver 
that,  by  means  of  antiphlogistic  contacts  of  the  nitrate 
crayon,  it  is  possible  to  cure,  and  that  speedily,  most  of 
the  inflammations,  and  their  accidents  met  with  in  this 
humble  department  of  clinical  medicine  or  surgery;  for 
it  is  to  be  remembered  that  few  of  them  are  attended 
with  any,  the  least  degree  of  ulceration,  as  we  have 
before  asserted. 

It  is  a  common  opinion,  and  it  is  generally  agreed  to 
say  so,  that  these  are  ulcers  on  the  womb;  and  there 
are  people  who  seem  never  to  fail  to  discover  an  ulcer 
upon  making  an  examination  with  the  speculum  ma- 
tricis.  An  immense  experience  in  a  populous  metropo- 
lis— an  experience  greatly  increased  by  the  resort  of 
numerous  invalids  from  the  country,  and  from  the  dif- 
ferent United  States — enables  me  with  confidence  to 
declare,  that  an  ulceration  of  the  womb  is  among  the 
rarest  of  disorders.  I  repeat  the  expression  of  my 
opinion,  that  these  disorders  and  framboisee  inflamma- 
tions and  hypertrophies  of  the  cervix,  have  been  misin- 
terpreted and  accounted  as  ulcerations,  which  they. were 
not,  the  superficies  being  covered  with  a  delicate  epithe- 
lium, yet  so  very  delicate  as  readily  to  give  way  and 
suffer  abrasion  under  improvident,  unskilful  manipula- 
tion with  the  tube  or  the  sponge. 

A  proper  antiphlogistic  and  resolvent  contact  of  the 
crayon  ought  not  to  destroy  even  this  delicate  epithe- 
lium; but  rather  to  make  it  more  firm  and  dense,  and 
so  planish,  as  it  were,  the  unevenness  down  to  the 
normal  surface  level.     In  this  way,  we  may  compel  the 


56  ACUTE    AND    CHRONIC    DISEASES 

drusy  or  tubercular  eminences  to  sink  down  again  to 
their  place,  and,  by  solidifying  the  epithelium,  give  a 
firm  physical  delimitary  support  to  the  before  debilitated 
capillaries  that  rose  up  in  the  form  of  a  soft  molluscum. 

My  patient  was  thus  treated.  She  was  also  advised 
to  take  abundantly  a  nutritious  diet,  with  a  copious  al- 
lowance of  Bordeaux  wine  and  water;  to  swallow,  soon 
after  each  daily  meal,  two  grains  of  iron  revived  by  hy- 
drogen, and  made  into  a  pill  with  clarified  honey ;  to 
get  into  the  open  air,  on  foot,  as  much  and  as  long  as 
possible,  and,  being  a  person  inclined  to  follow  the  in- 
structions, she  soon  recovered  a  good  state  of  health. 

As  incidental  to  this  part  of  our  explanations,  it 
may  be  proper  to  remark,  that  the  state  of  the  canal 
of  the  cervix  so  often  referred  to,  is,  in  all  probability, 
one  of  the  ordinary  causes  of  sterility.  In  examining 
these  structures  after  death,  we  have  observed  the 
whole  cylinder  of  the  canal  of  the  cervix  to  be  filled 
or  tamponed,  so  to  speak,  with  a  plug  of  viscid  lymph, 
so  obstructing  the  passage  as  to  render  it  apparently 
impossible  that  any  spermzoon  could  obtain  access  to 
the  uterine  cavity.  Certain  it  is,  that  some  sterile 
women  are  always  affected  with  this  excessive  albumi- 
nous mucous  production.  We  have  met  with  instances 
of  unrelieved  sterility  in  women  enjoying  the  most 
robust  health,  with  the  sole  exception  of  this  vexation, 
which  never  gave  any  pain,  nor  modified  the  mensual 
phenomena  in  the  least.  Many  women,  who  had  tem- 
porarily suspended  the  usual  succession  of  their  gesta- 
tions, apparently  in  consequence  of  this  derangement  of 


OF  THE  NECK  OF  THE  UTERUS.        57 

the  health,  have  again  conceived  after  the  cure  of  the 
albuminous  leucorrhcea;  or  rather,  the  inflammation  of 
which  it  was  the  sign  and  consequence. 

Surprise  has  often  been  expressed  on  observing  that 
married  women,  after  years  of  sterile  cohabitation,  have 
suddenly  become  fruitful.  In  these  instances,  the  want 
of  fruitfulness  could  not  depend  on  failure  of  the  ovu- 
lations ;  may  it  not  be  that  the  spontaneous  cure  of  a 
protracted  and  subacute  inflammation  of  the  kind  herein 
treated  of  may  have  restored  the  health,  and  so  given 
power  to  take  away  the  woman's  reproach  ? 

Continuing  the  plan  adopted  in  this  essay,  we  now 
observe  that  other  forms  of  cervical  inflammation,  than 
those  already  described,  will  present  themselves  to  the 
observation  of  the  clinical  practitioner ;  and  we  submit 
the  accompanying  drawing,  taken  from  the  life,  in  a 
case  which  proved  unexpectedly  rebellious  to  treatment, 
though  it  was  subdued  at  last. 

This  person,  a  lady  of  small  stature  and  delicately 
formed,  of  a  sanguine  choleric  temperament,  had  given 
birth  in  rather  too  rapid  succession  to  six  living  child- 
ren, and  experienced,  in  the  third  lying-in,  a  very  dan- 
gerous attack  of  childbed  fever ;  and,  a  few  years  later, 
subsequently  to  the  birth  of  her  sixth  child,  suffered 
from  a  severe  crural  phlebitis,  or  milk-leg.  The  health 
had  been  less  firm  than  usual  after  her  recovery  from 
the  phlebitis,  although  she  was  not  afterwards,  on  ac- 
count of  her  valetudinary  state,  confined  to  the  house. 

After,  for  a  long  time,  patiently  enduring  severe 
pains,  referred,  in  chief,  to  points  in  the  neighborhood 


58  ACUTE    AND    CHRONIC    DISEASES 

of  Poupart's  ligament  of  the  left  side,  with  distressing 
sensations  in  the  range  of  the  external  obturator  nerve, 
bearing-down  feeling,  backache,  debility,  loss  of  appe- 
tite, irregular  action  of  the  bowels,  and  dysmenorrhceal 
symptoms,  she  asked  for  advice.  There  was  incon- 
siderable fluor  albus,  no  positive  dysury,  nor  other  sign 
of  uterine  deviation  or  displacement.  Exercise  on  foot 
invariably  increased  the  pain,  and  the  jarring  of  car- 
riage-springs was  highly  annoying.  She  looked  dispi- 
rited and  wan. 

Touching  the  chirurgical  neck,  it  was  found  to  be 
excessively  solid,  with  the  posterior  lip  not  a  little 
longer  than  its  fellow.  The  touch  gave,  from  the  resist- 
ance, the  idea  of  scirrhous  induration;  and  was  so 
painful,  even  on  slight  pressure,  as  to  be  very  unwill- 
ingly borne,  and  then,  not  without  some  exclamations. 
The  left  angle  of  the  os  was  sulcated — as  if  it  had 
recovered  imperfectly  of  some  foregoing  laceration  in 
labor.  Pain  excited  by  this  pressure  was  felt  not  only 
at  the  point  of  contact,  but  severely  in  the  left  groin 
and  inner  side  of  the  thigh. 

The  lady  submitted,  under  advice,  to  an  examination 
by  the  metroscope,  and  it  disclosed  the  form,  size,  and 
hue,  portrayed  in  the  figure  (Plate  8,  Fig.  2).  A  long 
familiarity  with  maladies  of  this  class,  did  not  prevent 
the  writer  from  having  repeated  misgivings  as  to  the 
result  of  this  attack;  which  again  and  again  seemed  to 
take  upon  it  so  many  threatening  characteristics  of  car- 
cinoma, and  resisted  so  obstinately  the  most  careful, 
reasoned,  and  persevering  treatment,  that,  even   now, 


OF  THE  NECK  OF  THE  UTERUS.        59 

he  is  led  to  doubt  if  the  case  was  not  strongly  tinctured 
with  the  malignant  nature  in  question. 

It  was  treated  with  antiphlogistic  contacts  of  the 
nitrate  crayon,  with  emollient  injections  of  flaxseed 
mucilage,  with  anodyne  enemata,  containing,  each,  forty 
drops  of  tinct.  opii,  at  bedtime,  with  repeated  applica- 
tion of  Swedish  leeches  to  the  cervix ;  with  a  regulated 
diet,  occasional  baths,  a  soluble  state  of  the  bowels; 
much  rest  on  the  sofa,  and  the  use  of  hydriodate  of 
potassa,  combined  with  comp.  syr.  sarsa. 

Of  several  hundred  cases  of  inflamed  cervix  (at  vari- 
ous times,  for  many  years)  under  treatment,  this  ap- 
peared to  be  the  most  irresolvable.  Yet  it  began  at 
last  to  give  way,  and  slowly  yielded — so  completely, 
that  the  patient  was  advised  to  take  a  course  of  the 
waters  at  Saratoga ;  from  whence  she  returned  in  good 
health,  after  an  absence  of  a  few  weeks.  Since  that 
time  she  has  passed  through  a  healthy  gestation,  and 
has  given  birth  to  a  robust  infant  with  the  easiest  of  all 
her  labors.  During  the  dilating  processes  of  the  labor, 
the  whole  cervix  was  found  remarkably  healthful.  The 
recovery  was  fortunate ;  and,  she  has  very  good  reason 
to  rejoice  that  M.  Recamier  has  taught  the  profession 
not  only  how  to  make  a  physical  diagnosis,  but  also 
how  to  treat  these  dreadful  cases.  We  repeat  here,  that 
an  inspection  of  our  drawing  will  communicate  an  idea 
of  the  physical  appearances,  wellnigh  as  correct  as  the 
direct  observation  of  the  inflamed  cervix  itself.  It 
cannot  well  be  believed  that  such  a  form  of  inflamma- 
tion as  this  could  be  made  amenable  to  a  treatment  by 


60  ACUTE    AND    CHRONIC    DISEASES 

mere  vaginal  injection,  by  alterative  doses  of  mass, 
hydrarg.,  by  preparations  of  iodine  or  tartar  of  anti- 
mony, or  any  other  merely  constitutional  medication. 
It  is  true  that,  in  some  instances,  the  topical  applications 
may  have  been  either  incline  rent,  or  positively  injurious; 
and  it  must  ever  happen,  that  even  where  one  forms  in 
his  mind  a  correct  ideal  of  the  therapeutical  purpose  and 
act,  he  may  err  in  the  realization  of  it.  It  can  only  be 
said,  that  the  treatment  rarely  gave  rise  to  other  pain 
than  what  was  caused,  sometimes,  by  pressure  of  the 
instrument.  But  every  sensible  pressure  with  the  index 
finger  gave  as  much.  Be  this  as  it  may,  the  ultimate 
final  resolution  of  a  detestable  inflamed  induration  of 
the  cervix,  and  her  complete  recovery,  furnish  proof, 
that  the  method  (if  not  a  safe,  or  a  desirable  one)  is,  at 
least,  in  some  very  unpromising  instances,  crowned  with 
the  happiest  success. 

The  author  having  already  set  forth,  in  a  preceding 
part  of  this  paper,  his  views  in  relation  to  hypertrophied 
states  of  the  womb,  and  the  constitutional  proneness  of 
that  organ  to  undergo  hypertrophic  development,  he 
will  now  beg  to  call  attention  to  some  of  the  consequen- 
ces of  uterine  irritation,  that  differ,  at  least  in  form, 
from  those  already  adverted  to  and  illustrated. 

Women,  who  complain  of  intrapelvic  pain,  and  other 
disorders  of  the  lower  part  of  the  body,  are  inclined, 
in  general,  to  account  for  these  incommodities  by  refer- 
ring them  to,  what  they  call,  womb-complaints.  This 
term  is  so  vague  and  imprecise,  that  the  pronouncing  of 


OF  THE  NECK  OF  THE  UTERUS.        61 

it  rarely  excites  any  clear  precise  idea.  Among  these 
cases  of  womb-complaints,  probably  none  are  so  common 
as  those  which  depend  upon  retroversion  of  the  womb. 
So  frequently  does  this  affection  occur  in  the  course  of 
one's  medical  practice,  that  one  almost  acquires  a  dispo- 
sition, in  every  case,  before  examination,  to  suspect  it 
has  some  dependency  upon  retroversio  uteri.  The 
author  has  long  been  fully  convinced  that  retroversion 
of  the  womb  constitutes  seventy-five  per  cent,  of  all 
cases  of  sexual  disorders,  that  are  of  a  gravity  sufficient 
to  require  appeal  to  medical  advice.  This  may,  at  first, 
appear  to  be  an  exaggerated  estimate ;  but  it  will  pro- 
bably be  found  sustained  by  statistical  experience. 

An  inspection  of  Plate  3  shows  how  it  must  happen, 
that  alternating  states  of  fulness  or  voidness  of  the  uri- 
nary bladder  must  interest  the  uterus,  as  to  its  place. 
An  overfilled  bladder  of  urine,  by  thrusting  the  fundus 
backwards  towards  the  sacrum,  puts  violently  on  the 
stretch  the  ligamenta  rotunda ;  and,  as  the  uterus  is, 
to  a  certain  extent,  rigid  and  inflexible,  it  follows,  that 
if  the  fundus  is  thrust  back  so  as  to  stretch  the  round 
ligaments,  the  cervix  must  come  forward,  straining  at 
the  same  time  the  utero-sacral  folds — for  the  womb 
moves  by  the  way  of  see-saw — in  being  retroverted. 

A  great  many  women  and  young  girls  suffer  them- 
selves to  acquire  the  bad  habit  of  retaining  the  urine 
until  a  large  quantity  is  accumulated  within  the  blad- 
der. Thirty  ounces  of  liquid,  in  the  urinary  bladder, 
make  a  mass  as  big  as  a  quart  measure,  and  it  cannot 
but  thrust  the  uterus  injuriously  backwards,  causing  the 


62  ACUTE    AND    CHRONIC    DISEASES 

neck  to  see-saw  at  the  same  time  forward,  and  approach 
the  pubis. 

A  long  habit  of  this  kind  comes  at  last  to  ruin  the 
uterine  ligaments;  so  that  the  fundus,  being  wholly 
overset  backwards,  sinks  down  into  the  Douglass  cul-de- 
sac,  while  the  os  takes  a  permanent  place  near  the  sym- 
physis pubis ;  and  this  is  retroversion.  It  is  even  some- 
times a  congenital  malposition,  as  shown  by  Morgagni 
and  others. 

But,  let  it  be  remembered  that  the  womb  is  con- 
stitutionally prone  to  set  off  on  a  race  of  hypertrophic 
development,  and  we  may  then  understand  how  it  shall 
be  readily  provoked  to  commence  a  process  of  hypertro- 
phization,  by  the  awkward,  unnatural,  and  irritating 
posture  it  acquires  in  retroversion. 

We  have  met  with  some  of  these  cases  in  which  the 
womb  grew  so  much  that  the  fundus  was  jammed 
against  the  hollow  of  the  sacrum,  and  the  os  against 
the  symphysis,  or  on  the  soft  parts  above  it,  compress- 
ing the  bladder  most  mischievously,  but  not  at  all 
bending  the  womb  itself. 

In  other  specimens,  we  find  the  uterus  bent  like  a 
retort,  as  in  the  outline  figure  annexed.     The  angula- 

Fie.  1. 


OF  THE  NECK  OF  THE  UTERUS.        63 

tion,  in  some  of  the  examples,  is  almost  acute ;  so  that 
the  caliber  of  the  canal  of  the  neck  is  seriously  dimin- 
ished, and  its  function  as  an  efferent  duct  for  the 
menstrua,  in  a  measure  hindered ;  whence  we  have  dis- 
tressing dysmenorrhcea. 

Medical  men,  called  upon  to  diagnosticate  in  such 
cases,  should  be  very  careful,  first  to  establish  in  their 
minds  the  ideal  or  standard,  by  which  to  compare ; 
otherwise  they  will  be  apt,  upon  finding  the  whole 
pelvis  occupied,  or  blocked  up  with  an  immense  and 
immovable  solid  mass,  to  conceive  of  it  as  a  tumor; 
whereas  it  may  prove  in  fact  to  be  no  tumor,  but  only 
an  overset  and  enormously  hypertrophied  uterus. 

We  have  met  with  repeated  examples  of  such  mis- 
interpretation of  the  case,  women  being  supposed  to 
labor  under  tumors  within  the  pelvis,  whereas  the  sup- 
posed tumors  were  nothing  more  than  the  posterior 
aspect  of  the  corpus  and  fundus  uteri,  turned  over  and 
touched  through  the  posterior  membranous  wall  of  the 
vagina ;  and  wholly  disappearing  as  soon  as  the  womb 
could  be  properly  reposited. 

A  young  lady  was  brought  to  the  Author  from  a 
distant  State,  being  accompanied  by  her  attending 
physician.  In  this  case,  a  drawing  was  made,  after 
the  most  careful  examination,  of  which  we  subjoin  a 
copy — Plate  9. 

The  figure  is  one-fourth  less  than  the  natural  size, 
and  is  made  to  exhibit  a  cross  section  of  the  pelvis  con- 
ducted through  the  pubis  and  sacrum,  with  the  fifth 
lumbar  vertebra.      In  making  this  exploration,  it  was 


64  ACUTE    AND    CHRONIC    DISEASES 

easy  to  verify  the  diagnostic  by  hypogastric  palpation, 
and  by  examination  conducted  both  by  the  rectum  and 
the  vagina.  The  cervix  was  bent,  as  in  the  figure,  and 
the  body  of  the  uterus  enlarged  and  turned  over  deep 
into  the  recto-vaginal  cul-de-sac.  The  entire  mass  was 
so  packed  and  immovably  fixed  in  the  excavation  as  to 
make  it  impossible  for  one  to  raise  it  by  any  degree  of 
upward  pressure  with  the  fingers,  and  the  canal  was  too 
much  curved  to  admit  of  correcting  the  deviation  by 
using  Professor  Simpson's  sound.  In  general  respects, 
the  patient's  health,  being  not  very  greatly  affected,  she 
was  advised  to  return  to  her  home  and  undergo  at- 
tempts to  reposit  the  organ  by  the  use  of  caoutchouc 
bottles  filled  with  curled  hair,  a  method  proposed  by  M. 
Hervez  de  Chegoin.  The  result  has  not  been  commu- 
nicated to  us,  farther  than  to  inform  us  that  the  lady's 
health  is  improved. 

We  have  stated  this  case,  because  the  diagram  was 
made  after  due  reflection,  at  the  time  of  our  consulta- 
tion, and  because  we  rely  upon  its  accuracy  as  a  repre- 
sentation of  not  infrequent  cases  of  disorders  of  the 
cervical  portion  of  the  uterus.  Certainty,  we  have  met 
with  a  considerable  number  of  analogous  forms  of  dis- 
ordered womb  for  many  years  past. 

To  reposit  the  uterus,  and  maintain  it  so,  would  ap- 
pear to  be  the  chief  indication  in  such  a  case  ;  since 
that  alone  would  be  to  place  it  in  a  condition  to  obey 
again  its  normal  or  generical  law  of  form  and  substance. 
We  repeat  that  a  considerable  number  of  instances,  in 
which  the  womb  was  greatly  augmented  in  every  di- 


OF  THE  NECK  OF  THE  UTERUS.        65 

mension,  in  consequence  of  the  irritation  superinduced 
by  retroversion,  have  been  treated  with  the  happiest 
success,  on  this  principle,  by  the  author  of  this  essay. 

To  show  how  great  is  the  change  wrought  in  the 
hypertrophied  uterus  by  such  reposition,  we  annex  two 
figures  (Plate  10,  Figs.  1  and  2). 

These  drawings  represent  one  and  the  same  uterus, 
Fig.  1  being  a  view  of  it  when  the  hypertrophy  was  at 
the  highest  stage  ;  and  Fig.  2,  when  it  had  entirely  dis- 
appeared. 

The  patient  was  a  woman  39  or  40  years  of  age ;  her 
children  were  all  grown  up,  except  the  youngest,  a 
daughter,  some  13  or  14  years  old. 

When  first  called  to  the  case,  the  belly  was  tumid, 
and  to  a  considerable  degree  tense  and  sonorous  on  per- 
cussion, but,  with  the  integuments,  so  strictly  drawn 
over  the  abdominal  contents  as  to  prevent  any  satisfac- 
tory conclusion  concerning  the  state  and  nature  of  the 
substance  giving  rise  to  the  so  great  distension. 

There  were  dysury  and  pelvic  fulness,  with  tenesmus ; 
the  menstrua  absent,  causing  some  suspicion,  on  her 
part,  of  existing  gestation. 

Touching  disclosed  a  retroversion.  The  pelvic  cavity 
was  so  full  as  to  seem  packed.  The  os  uteri  was  higher 
than  the  top  of  the  symphysis  pubis,  and  permanently 
there.  The  substance  of  the  womb  could  be  traced 
down  and  backwards  to  the  hollow  of  the  sacrum. 

This  womb  was  reposited,  completely,  and  with  con- 
siderable relief.  Subsequently,  after  severe  catharsis, 
it  became  possible  to  trace  its  outline  in  the  belly,  and 
5 


66  ACUTE    AND    CHRONIC    DISEASES 

Professor  Simpson's  womb-sound  was  used,  in  order  to 
clear  up  the  diagnosis.  I  next  very  slowly  and  cautiously 
passed  the  sound  into  the  os  uteri,  and  it  advanced  with- 
out giving  pain  or  encountering  any  obstruction,  until 
the  probe-point  of  it  was  arrested  by  coming  in  contact 
with  the  vault  of  the  fundus.  The  sound  had  gone  six 
and  a  half  inches  into  the  cavity,  which  proves  that  the 
Fig.  1,  Plate  10,  is  correct  as  to  its  length.  I  am  an- 
swerable that  the  volume  of  the  chirurgical  neck  and 
the  orifice  are  also  rightly  illustrated,  while  the  trans- 
verse diameter  is  as  near  the  truth  as  I  could  make  it 
by  the  most  careful  measurement,  spanning  it  with  the 
thumb  and  fingers  through  the  abdominal  walls,  relaxed 
after  the  cathartic  operations. 

The  rectification  of  the  position  did  not,  however, 
save  the  life  of  the  unfortunate  patient,  who  proved  to 
be  also  affected  with  a  colloid  degeneration  of  the  ovary. 
This,  which  became  an  enormous  mass  of  disease,  spread 
its  ravages  far  and  wide  within  the  peritoneal  cavity, 
and  she  died  at  the  end  of  six  months  from  the  time 
here  referred  to,  after  repeated  paracentesis  abdominis. 
Upon  making  a  post-mortem  examination,  the  uterus  was 
found  to  be  of  the  size  and  form  represented  upon  the 
Fig.  2,  Plate  10. 

The  case  appears  to  us  to  present  points  of  great  in- 
terest, since  it  shows  that  a  vast  increase  of  the  volume 
of  the  womb,  unconnected  with  conception  and  gesta- 
tion, is  no  more  inconsistent  with  recovery  of  the  non- 
gravid  form  and  size,  than  a  similar  recovery  after 
healthy    pregnancy.      The    measurement,   made   with 


OF  THE  NECK  OF  THE  UTERUS.        67 

Simpson's  sound,  and  the  opportunity  to  determine  the 
appearances  of  the  organ,  after  the  death  of  the  lady 
from  colloid  cancer,  rendered  it  an  extremely  favorable 
example  for  illustrating  the  views  set  forth  in  this  re- 
port on  the  subject  of  uterine  hypertrophy.  It  ought 
not  to  be  forgotten  that  this  womb  admitted  of  the  in- 
troduction of  six  and  a  half  inches  of  Simpson's  womb- 
sound  soon  after  it  was  relieved  of  its  retroversion,  and 
that  the  lady  perished,  some  six  months  later,  with  de- 
generation of  the  ovary  and  other  parts.  If,  therefore,  the 
hypertrophy  of  the  womb  had  had  any  dependency  upon 
the  ovarian  disease,  we  should  not  expect  to  find  it  re- 
duced back  to  its  normal  size ;  whence  we  infer  that,  to 
relieve  it  from  its  dislocated  position,  was  the  very  thing 
necessary  for  its  cure. 

Since  writing  the  above,  we  have  concluded  to  pre- 
sent a  drawing  (Plate  13,  Fig.  1),  exhibiting  the  appear- 
ance of  a  case  of  hypertrophy  of  the  cervix  uteri,  which 
came  under  care  of  the  author.  It  was  the  case  of  a 
maiden  lady  of  some  35  years  of  age.  It  is  believed  that 
this  picture  may  serve  to  communicate  a  correct  notion 
of  the  physical  characteristics  of  the  chirurgical  neck  in 
the  instance  referred  to.  This  patient  recovered  under 
resolvent  contacts  of  the  nitrate  crayon,  and  the  exhibi- 
tion of  internal  remedies  of  an  alterative  kind.  Proba- 
bly such  considerable  augmentation  as  this  of  the  cylin- 
drical portion  of  the  womb,  yet  not  involving  a  state  of 
general  hypertrophy  of  the  organ,  will  not  be  very  often 
met  with  in  practice.  Still,  cases  of  the  kind  are  of 
sufficient  frequency  to  give  interest  to  the  description  of 


68  ACUTE    AND   CHRONIC   DISEASES 

such  a  great  change  in  the  volume  of  the  neck  of  the 
womb.  In  this  instance,  and  in  others  much  resembling 
it,  we  have  not  been  accustomed  to  detect  signs  of  posi- 
tive inflammation  in  the  part.  Nevertheless,  it  would 
be  reasonable,  from  the  resolving  or  deobstruent  power 
of  the  nitrate  contacts  in  positively  inflamed  cervix,  to 
infer  a  similar  availability  in  mere  hypertrophic  irrita- 
tion; and  practical  experience  justifies  such  an  infer- 
ence. 

Another  drawing  (Plate  11),  herewith  presented, 
shows  the  appearance  of  a  cervix  and  os  examined  by 
the  writer.  The  patient  was  a  resident  of  a  neighbor- 
ing State,  who,  some  months  previous  to  her  visit  to 
Philadelphia,  was  visited,  at  her  residence,  in  consulta- 
tion. The  womb,  at  that  time,  was  completely  retro- 
verted,  and  so  much  enlarged  as  to  fill  the  excavation j 
pretty  much  as  it  is  filled  by  the  presenting  part  in  a 
labor.  It  was,  at  the  time,  immovable  by  the  hand, 
but  was  afterwards  slowly  raised  by  means  of  the 
caoutchouc  bags  or  pessaries  of  Hervez :  vid.  Trans. 
Acad.  Roy.  de  Med.  torn.  ii.  p.  319.  She  was  con- 
sidered to  be  dangerously  ill ;  but  began  to  recover 
when  the  womb  was  replaced  and  relieved.  After  ac- 
quiring a  tolerable  degree  of  health  and  strength,  she 
proceeded  to  Philadelphia,  complaining  of  bearing-down 
pains  and  intropelvic  distress,  with  catamenial  disorder, 
attributable  to  the  remaining  and  uncured  disorders  of 
the  uterus. 

The  metroscope  showed  the  os  tincse  and  cervix  as 
they  seem  in  the  figure,  in  which  we  have  represented  the 


OF  THE  NECK  OF  THE  UTERUS.        69 

organ  foreshortened.  The  unhealthy  state  of  the  cervix 
was  attested,  not  only  by  its  augmented  size,  the  tuber- 
cular elevations  of  the  margins  of  the  orifice,  and  the 
red  inflammation,  but  also  by  the  viscid  albuminous  dis- 
charges from  the  canal  of  the  neck. 

The  treatment  consisted,  mainly,  in  the  use  of  anti- 
phlogistic impressions  made  by  the  nitrate  of  silver  pen- 
cil. The  inflammation  of  the  mucous  body  being  cured, 
the  disordered  womb  returned  to  its  accustomed  obedi- 
ence to  its  generical  law  of  form  and  substance,  and 
recovered  its  normal  magnitude. 

An  inspection  of  this  specimen  of  disorder,  remaining 
after  a  very  great  hypertrophy  had  been  reduced, 
strengthens  the  inference  hereinbefore  expressed,  that 
the  precise  appearances  manifested  by  the  os  and  cervix, 
in  inflammation,  are  accidental — being  either  drusy,  tu- 
berculated,  or  smooth  and  even  in  surface ;  and  now  we 
present  a  case  of  hypertrophy,  of  which  Plate  12  is  a 
just  and  fair  exponent  of  the  appearance,  as  it  was 
examined  by  us,  both  by  touching  and  by  the  Recamier 
speculum,  as  well  as  by  M.  Joubert  de  Lamballe's  ivory 
metroscope. 

The  os  uteri  was  of  this  size,  and  the  cervix  could  not 
be  embraced  within  the  aperture  of  the  Joubert  instru- 
ment. The  neck  of  the  womb,  as  far  as  it  could  be 
explored  by  thrusting  the  fingers  upwards  all  around  the 
neck,  in  the  vaginal  cul-de-sac,  was  of  this  shape,  and 
flaring  out  at  this  rate.  The  fundus,  which  was  readily 
detected  in  the  hypogaster,  was  as  high  and  as  ample  as 
is  here  seen. 


70  ACUTE    AXD    CHRONIC    DISEASES 

The  tint  of  the  inflammation  of  the  os  tineas  is  care- 
fully reproduced  in  the  drawing. 

The  patient  had  been  in  apparent  danger  of  imminent 
death  a  few  weeks  before  this  sketch  was  taken,  and 
from  causes  connected  with  this  uterine  disease.  She  is 
the  mother  of  a  numerous  family. 

Some  leechings  of  the  chirurgical  neck,  and  repeated 
applications  of  nitrate  of  silver  to  it,  served  to  cure  the 
cervical  inflammation,  and  the  womb  returned  to  the 
size  shown  in  Plate  13,  Fig.  2.  The  patient  was  soon 
restored  to  health,  after  several  years  of  the  greatest 
inconvenience  and  many  most  painful  and  alarming 
attacks  endured  before  this  treatment  began. 

No  man,  much  experienced  in  the  treatment  of  ute- 
rine hypertrophies,  can  have  failed  to  meet  with  persons 
in  whom,  to  examine  by  touching,  was  to  find  the  pel- 
vis filled  up  solid,  so  to  speak,  with  the  os  uteri  close  to 
the  pubis.  We  have  met  with  not  a  few  such  instances ; 
and  it  has  happened  more  than  once,  that  we  have  been 
so  much  disheartened  upon  a  first  examination,  as  to  be 
prompted  to  make  a  diagnosis  of  incurable  disease. 

In  one  case,  a  lady  from  the  distant  South,  and  in  the 
most  wretched  health,  had  the  excavation  so  filled  up 
with  a  hypertrophied  and  solidified  mass,  that  there  was 
scarcely  space  sufficient  to  allow  an  introduction  of  the 
index  finger  betwixt  this  mass  and  the  floor  of  the  pel- 
vis upon  which  it  rested.  The  neck  and  os  were  near 
the  symphysis.  It  was  a  case  of  complete  immobility  of 
the  uterus,  which  seemed  as  big  as  a  foetal  head  in  a 
labor  at  term.     By  means  of  a  Para  gum-elastic  bottle, 


OF  THE  NECK  OF  THE  UTERUS.        71 

a  very  small  one,  stuffed  with  mattress-hair,  we  made 
an  oviform  pessary,  a  little  bigger  than  the  thumb. 
This  was  forced  into  the  vagina,  and  retained  by  an 
outer  compress.  In  a  few  days,  one  somewhat  larger 
was  substituted.  The  elasticity  or  spring  of  the  caout- 
chouc bottle  steadily  pressed  the  mass  upwards,  and  the 
size  of  the  balls  being  occasionally  increased,  we  had  the 
satisfaction  to  find,  after  no  very  protracted  service,  that 
the  intropelvic  tissues  had  acquired  a  natural  character, 
and  the  lady  returned  to  her  country  in  very  good 
health,  which  she  still  enjoys. 

We  might  relate  a  great  number  of  cases  to  show  that 
upon  removing  the  causes  of  augmented  volume  of  the 
womb,  it  falls  speedily  into  its  generical  habits  of  nutri- 
tion, but  we  abstain,  considering  that  the  declaration  of 
this  doctrine,  indeed,  with  a  few  illustrations  and  expla- 
nations, ought  to  suffice  to  present  the  matter  clearly  to 
the  apprehension  of  any  of  our  intelligent  colleagues. 

It  is,  by  many,  very  confidently  supposed  that  the 
use  of  escharotics  in  these  cervical  inflammations  will 
speedily  suffice  to  restore  the  health  of  the  patient ;  and 
those  who  are  most  accustomed  to  use  them,  are,  per- 
haps, more  thoroughly  convinced,  than  any  other  per- 
sons, of  their  great  efficacy.  It  will  not,  however, 
always  answer  to  make  the  application  to  the  mammil- 
lary  part  of  the  cervix  alone,  because  the  inflammation 
is,  in  some  of  the  examples,  found  to  attack,  with  greater 
or  less  severity,  the  corpus  mucosum  and  the  mucous 
follicles  of  the  candlis  cervicis.  Here  it  is  proper  to 
apply  the  nitrate  by  means  of  Lallemand's  port-caustic, 


72  ACUTE    AND   CHRONIC   DISEASES 

or  by  means  of  a  fitch  pencil,  which  is  composed  of  hairs 
so  rigid  that  one  can  readily  pass  it,  loaded  with  a  solu- 
tion, some  distance  up  the  canal.  It  would  be  dan- 
gerous to  inject  such  solution  with  a  syringe  whose 
canula  should  be  introduced  within  the  os.  But  after 
all,  we  must  meet  with  cases,  at  first  to  all  appearance 
tractable,  that  will,  in  the  end,  be  found  to  foil  our  most 
patient  and  well-reasoned  efforts  to  cure  them. 

One  makes  up  a  diagnosis  upon  the  means  or  elements 
of  a  diagnosis — there  is  no  other  way.  One  cannot, 
therefore,  positively  declare  what  is  the  state  of  the  tis- 
sues that  compose  the  walls  of  the  canal  of  the  neck, 
and  it  may,  and  does  happen  that  those  tissues  undergo 
changes  which  render  a  cure  by  the  means  herein 
treated  of  out  of  the  question.  All  the  parts  that  come 
into  view  might  be  apparently  little  changed,  while 
other  parts  beyond  the  reach  of  sight  and  touch  should 
be  in  a  very  different  condition.  Here  is  a  drawing 
taken  from  a  specimen  in  the  author's  collection,  that 
illustrates  this  point.     (Plate  14.) 

This  figure  answers  correctly,  as  to  its  scale,  to  the 
preparation  from  which  it  was  drawn ;  and  shows  how 
considerably  the  womb  was  enlarged  at  the  time  of  the 
woman's  death;  upon  looking  at  the  specimen,  after 
closing  the  incision,  we  might  be  easily  misled,  so  far  as 
to  think  such  a  case  would,  in  life,  be  readily  amenable 
to  treatment  like  Fig.  12 ;  but  on  cutting  it  open  by  an 
incision  from  the  fundus  down  to  the  cavity  and  canal, 
and  to  the  os,  it  is  seen  that  the  interior  is  irremediably 
diseased,  the  substance  of  the  walls  being  converted  into 


OF  THE  NECK  OF  THE  UTERUS.        73 

a  sort  of  pennicillated  structure,  of  which  the  ends  of 
the  pencils  exhibit  small  tubercular  elevations  all  along 
the  inner  wall. 

A  casual  examination  by  touching,  or  even  a  careful 
metroscopy  could  not  be  expected  to  clear  up  such  a 
diagnosis  as  this  one;  and  all  attempts  to  restore  a 
healthful  crasis  and  form  to  such  degenerated  tissues,  by 
leeches,  by  escharotics,  either  on  the  outside  of  the  neck 
or  within  the  canal,  must  have  failed.  We  know  nothing 
farther  of  this  case — it  having  come  into  our  possession 
by  the  politeness  of  a  stranger.  Nevertheless,  it  is  a 
specimen  most  useful  in  the  study  and  minute  research 
so  desirable,  as  to  these  recondite  sexual  maladies.  We 
have  recently  witnessed  the  death  of  a  fine  woman,  who 
perished  under  this  precise  form  of  disorder  immensely 
aggravated. 

Changes  taking  place  in  parts  of  the  texture  of  the 
inner  wall  of  the  cervix  must  be  as  various  as  accident 
could  make  them.  Such  a  pennicillated  degeneration 
as  the  above,  being  one  form,  it  is  not  difficult  to  con- 
ceive of  other  modifications  as  producing  either  fibrous 
or  cellular  polypus,  or  the  more  unmanageable  forms  of 
Hosmatomatous  degeneration,  of  which  we  have  met 
with  not  a  few  examples  in  our  practice,  and  we  shall 
now  introduce  into  our  Essay  the  figure  (Plate  15)  repre- 
senting a  case  which  was  for  a  considerable  length  of 
time  under  treatment  without  any  useful  influence  being 
produced  therefrom. 

The  womb  was  carefully  examined,  with  a  view  to 
determine  its  dimensions  and  probable  weight.     It  was 


74  ACUTE    AND    CHRONIC    DISEASES 

not  more  than  four  inches  in  its  longest  diameter. 
The  os  was  of  an  oval  shape,  and  the  edges  or  lip  was 
much  condensed — to  such  a  degree,  indeed,  as  to  com- 
municate, by  touching,  the  idea  of  scirrhous  induration. 
Projecting  very  little  beyond  the  plane  of  the  orifice 
was  a  hsematomatous  mass,  that  evidently  sprung  from 
the  right  side  of  the  wall  of  the  canalis  cervicis  by  a 
broad  origin.  This  bleeding  tumor  is  well  represented 
in  the  drawing,  in  which  the  chirurgical  neck,  fore- 
shortened, is  seen  to  look  like  a  bourrelet  or  ring  pro- 
jecting in  the  vagina,  which  is  opened. 

The  hemorrhages,  here,  were  on  some  occasions  very 
threatening.  There  was  little  encouragement  to  be 
taken  from  the  suggestion  to  remove  the  fungus  by 
strangulation — a  step  forbidden,  also,  by  the  delicate 
state  of  the  woman's  general  health. 

Without  indulging  idle  hopes  of  effecting  a  cure,  and 
with  clear  understanding  that  no  promises  to  that  effect 
were  given,  or  any  flattering  hopes  held  out,  the  case 
was  conducted  for  a  few  months  under  very  unfavor- 
able circumstances,  by  means  of  nitrate  cauterizations, 
destructive  as  to  the  ha3matorne,  but  antiphlogistic  as 
to  the  cervical  ring.  They,  perhaps,  cannot  be  said  to 
have  done  any  good;  unless,  indeed,  we  might  attribute 
to  them  the  diminished  frequency  and  force  of  the 
hemorrhages,  and,  perhaps,  also  some  positive  reduction 
of  the  fungus  itself. 

Circumstances  rendered  it  inexpedient  to  continue 
these  attempts  at  amelioration,  which  were  unattended 
with  pain  or  any   other  sanitary  inconvenience.     The 


OF    THE    NECK    OF    TIIE    UTERUS.  75 

treatment  was  repeated  about  once  in  every  seven  days, 
from  the  date  in  May,  1852,  until  the  close  of  autumn. 
Certainly  no  aggravation  was  noticeable  up  to  the  final 
period  of  these  attempts;  and  the  patient  went  away 
supposing  herself  to  be  somewhat  improved  in  general 
health.     She  is  since  dead. 

As  a  general  conclusion,  a  physician  might  venture, 
in  such  cases,  to  pronounce  them  incurable. 

Women  often  complain  of  irregular  mensual  returns, 
saying,  that  while  the  legitimate  periods  are  duly  and 
healthfully  observed,  they  are,  in  addition,  vexed  with 
an  occasional  show  after  any  considerable  exertion. 
Women  are  apt  to  regard  every  sanguineous  discharge 
from  the  genitalia  as  menstrual  discharge. 

All  those  who  recognize  the  truth  that  menstruation 
is  one  of  the  phenomena  of  ovulation,  will  at  once  sus- 
pect that  such  irregular  markings  must  arise  from  some 
cause  other  than  the  physiological  hypersemia  of  the 
ovulative  act.  And,  in  fact,  it  is  mostly  found,  upon 
due  inquiry,  that  the  patient  has  the  raspberry-colored 
inflammation  of  the  cervix,  already  described ;  or  she 
has  certain  small  vivaces,  or  bunches  of  red  cellular  and 
capillary  tissue,  which  are  either  found  peeping  out  at 
the  plane  level  of  a  somewhat  patulous  os  tineas,  or 
jutting  quite  forth  out  of  and  beyond  it,  and  attached 
by  a  delicate  peduncle  or  footstalk. 

No  one  could  expect  to  cure  such  a  disorder  as  this 
by  any  sort  of  constitutional  therapy,  or  by  any  vaginal 
injections;  and  it  is  not  safe  to  leave  them  to  their  own 
tendencies,  which  would  perhaps  convert  them  into  very 


76  ACUTE   AND    CHRONIC    DISEASES 

troublesome  bleeding  polypi — many  of  which  are  to  be 
met  with  in  a  long  professional  course  of  observation. 
A  specimen  of  this  kind  is  seen  in  the  annexed  figure 
(Plate  16,  Fig.  1).  It  represents  the  os  uteri  of  a  lady, 
who,  without  having  much  real  indisposition,  was  never- 
theless excessively  annoyed  by  circumstances  like  those 
we  have  now  detailed;  and  who  indulged  apprehensions 
of  some  disastrous  term  to  them.  Examine  the  draw- 
ing: it  so  very  accurately  exhibits  the  appearance  both 
of  the  neck  of  the  womb,  and  the  little  tumor  or  ex- 
crescence, that  it  scarcely  requires  description.  Never- 
theless, it  is  proper  to  call  attention  to  the  hyperemia, 
or  inflammatory  turgescence  of  the  os  tineas,  and  to 
suggest  the  notion  that  this  redness  and  appearance  of 
phlogosis  probably  extended  some  distance  upwards 
within  the  canalis  cervicis,  thus  maintaining  a  molimen 
hemorrhagicum,  which,  upon  the  slightest  provocation, 
might  cause  a  moderate  gush,  or  marking  of  blood  to 
appear,  as  particularly  after  a  sexual  union. 

In  a  great  many  cases  like  this,  it  is  customary  with 
the  author  carefully  to  seize  the  excrescence,  or  nascent 
polypus,  with  the  dressing  forceps,  and  so  twist  it  off  at 
the  base,  if  practicable,  and,  immediately  afterwards,  to 
apply  the  nitrate  pencil  strongly  to  that  base,  or,  on 
some  occasions,  to  use  a  camel-hair  brush  dipped  in  acid 
nitrate  of  mercury,  which  answers  well  and  is  followed 
by  no  inconvenience,  particularly  if  a  small  velvet 
sponge,  thoroughly  imbibed  with  soap-suds,  is  immedi- 
ately afterwards  pressed  against  the  surfaces.     The  soap 


OF  THE  NECK  OF  THE  UTERUS.        77 

decomposes  the  excess  of  acid,  and  prevents  the  spread- 
ing of  the  escharotic  beyond  the  place  of  contact. 

One  need  not  expect  that  the  avulsion  of  these  little 
polypi  shall  certainly  effect  the  cure — for  they  are  very 
likely  to  be  reproduced;  probably,  because  only  the 
most  outward  parts  have  been  removed.  When  pro- 
perly removed,  even  down  to  the  very  source,  it  is  un- 
likely to  reappear;  but  a  second  and  a  third  attempt 
should  be  made,  if  necessary.  The  case  above  illustrat- 
ed was  cured  in  1851,  and  to  all  appearance  remained 
so — the  lady  having  no  annoyance  of  the  kind  until,  in 
the  winter  of  1852-3,  she  began  again  to  perceive  signs 
of  its  return,  and  now  she  has  an  excrescence  like  the 
one  in  the  drawing,  at  the  left  angle  of  the  os. 

We  have  other  drawings,  exhibiting  cases  in  which 
man3T  such  little  excrescences  were  observed  to  jut  forth 
of  the  opened  os,  looking  not  unlike  so  many  very  ripe 
red  currants.  We  have  treated  them  as  above  proposed, 
and  with  satisfactory  results.  It  seems  needless  to  in- 
troduce many  of  them  here.  Nevertheless,  we  have  in- 
troduced the  figure  (Plate  17),  showing  the  appearance 
of  the  excrescences  protruding  like  ripe  currants  from 
the  os  tincce,  as  mentioned  on  the  opposite  page.  In  this 
case,  under  treatment  in  the  spring  of  1853,  there  was 
hypertrophy  of  the  womb  to  such  degree,  as  to  allow  the 
fundus  to  be  felt  quite  two  and  a  half  inches  higher 
than  the  plane  of  the  superior  strait. 

In  continuation  of  these  clinical  details,  we  now  re- 
mark, that  the  lady  from  whom  the  drawing  (Plate  16, 
Fig.  2)  was  taken,  complained  of  monorrhagia  gradually 


78  ACUTE   AND    CHRONIC    DISEASES 

increasing  in  violence,  and  settling  at  length  into  an 
incessant  drainage,  under  which  she  became  excessively 
weakened  and  pallid.  She  had  borne  no  child  for  some 
sixteen  years,  and,  like  a  majority  of  women  similarly 
affected,  was  confident  that  her  trouble  arose  from  what 
they  call  change  of  life.  She  refused,  during  some 
eighteen  months,  to  submit  to  a  physical  diagnosis,  and 
became,  at  length,  so  dreadfully  affected  with  hydrsemia, 
that  her  life  seemed  to  be  in  great  danger.  She  was 
repeatedly  informed  that  the  word  change  of  life,  as  used 
in  general,  conveys  no  distinct  idea,  and  that  her  issue 
of  blood  must  arise  from  some  organic  fault. 

At  length  the  blood,  from  continual  waste  of  the  solid 
constituents  of  it,  became  so  dilute,  so  hydremic,  that 
she  could  not  walk  across  the  carpet  without  bringing 
on  palpitation,  nor  ascend  the  stairs  but  with  caution, 
and  always  with  much  difficulty.  Seeing  that  she  had 
no  other  hope  of  amendment,  she  submitted  to  an  ex- 
amination, whereupon  the  small  pedunculated  vascular 
excrescence,  or  polypus,  was  discovered,  as  shown  in 
Plate  16,  Fig.  2.  It  was  immediately  twisted  off.  The 
hemorrhages  never  returned  afterwards,  and  she  has  had 
good  health  these  now  many  years. 

This  example  and  statement  suffice  to  fulfil  our  pur- 
pose in  this  relation,  which  is  the  reason  why  we  detail 
no  other  similar  instances — which  wre  could  do,  drawling 
on  the  stores  of  our  personal  experience  in  practice. 

It  is  of  the  utmost  importance  in  the  practice  of 
physic  and  surgery,  to  make  absolutely  correct  diagnos- 
tications,  since  all  our  prognosis,  as  well  as  treatment, 


OF  THE  NECK  OF  THE  UTERUS.        79 

which  is  contained  within  the  diagnosis,  depends  upon 
being  right  in  the  beginning. 

This  opinion  will  be  admitted  to  be  just  by  all  those 
who  belong  not  to  the  empirical  schools  of  our  art,  but, 
on  the  contrary,  adhere  to  the  rationalists  in  Medicine. 

There  is  a  great  liability,  even  among  the  most  ex- 
perienced men,  to  be  led  into  ludicrous  or  even  fatal 
mistakes  in  the  diagnostication  of  the  so-called  diseases 
of  the  cervix. 

A  lady  came  to  Philadelphia  complaining  of  uterine 
disease,  that  had  baffled  her  physicians  at  home,  and 
applied  for  advice  to  an  expert.  Upon  some  considera- 
tion, the  author  was  invited  to  attend  in  consultation, 
and  dissented  from  the  opinion  that  was  entertained  by 
the  attendant. 

Patient  had  been  affected  with  some  form  of  violent 
intro-pelvic  inflammation,  which,  we  believe,  had  been 
regarded  as  metritis,  by  a  misapprehension  of  its  seat. 
After  protracted  and  great  suffering,  and  after  several 
operations  with  the  knife — the  precise  nature  of  which 
we  do  not  know — she  was  observed  to  have  the  vagina 
so  much  diminished  in  length,  that  her  relations  of  a 
marital  nature  became  impossible.  She  came  to  Phila- 
delphia, as  before  mentioned.  The  canal  of  the  vagina 
was  about  an  inch  in  depth,  and  no  more.  At  the 
bottom  of  this  cul-de-sac  was  a  firm  substance,  that  was 
mistaken  for  the  chirurgical  neck,  and  the  delicate  aper- 
ture in  it  for  the  os  uteri. 

To  the  touch,  such  a  case  presents  the  greatest  simili- 
tude to  the  mammillary  projection  of  the  womb,  and  is, 


80  ACUTE    AND    CHRONIC    DISEASES 

therefore,  a  great  stumbling-block  in  the  way  of  diag- 
nosis. The  medical  gentleman,  whom  I  met,  insisted 
that  it  was  the  os  uteri,  and  that  adhesion  of  the  vagina 
to  the  whole  exterior  vaginal  cervix  gave  it  the  present 
appearance,  as  at  a  in  the  diagram  on  the  next  page. 

Dissenting  from  this  opinion,  we  averred  with  equal 
confidence  that  the  womb  could  not  be  touched,  nor 
even  approached,  and  that  the  so-called  os  was  nothing 
more  than  one  of  the  apertures  in  a  long  vaginal  stric- 
ture, and  that  the  womb  itself  was  not  at  all  implicated 
in  the  disorder,  save  in  so  far  as  it  was  imprisoned 
above  this  impracticable  stricture,  amounting  nearly  to 
atresia  vaginae.     See  (b)  in  the  diagram. 

Some  months  subsequent  to  these  discussions,  the  lady 
returned  to  Philadelphia,  and  placed  herself  under  the 
sole  direction  of  the  writer  of  this  statement,  and  went 
away  cured. 

On  the  next  page  we  have  given  an  outline  drawing, 
or  diagram,  which  shows  how  readily  one  might  mistake 
the  thickened  bourrelet  (a)  for  a  vaginal  cervix  and  os 
uteri;  whereas,  in  truth,  the  os  uteri  is  above,  and  in 
the  free  part  of  the  vagina  marked  (b) . 

To  look  at  the  diagram,  it  is  easy  to  perceive  the 
truth  as  to  such  a  case,  while,  in  practice,  the  diagnos- 
tication  had,  and  has  deceived  many  an  experienced  and 
able  physician. 

We  have  now  under  treatment  a  case  precisely  ana- 
logous, affecting  a  woman  about  fifty-five  years  of  age, 
which  was  handed  over  to  us  by  an  eminent  practi- 
tioner, who  had  treated  it  for  some  time  under  the  con- 


OF    THE    NECK    OF    THE    UTERUS. 


81 


viction  that  what  he  touched,  as  in  the  figure  (at  a), 
was  the  os  tineas,  in  a  state  of  cancerous  induration. 
And  it  ought  to  be  observed  that,  in  all  such  instances 

Fig.  2. 


coming  under  our  notice,  we  have  found  the  part  so 
very  solid  and  scirrhous,  as  to  lead  to  fears  that  it  could 
not  be  amenable  to  any  power  of  resolution.  It  is  well 
known  that  some  urethral  strictures  do  become  almost 
callous. 

When  called  to  examine  the  state  of  the  parts  in  this 
6 


82  ACUTE   AND   CHRONIC    DISEASES 

case,  we  were,  at  first,  startled  to  find  such  an  appear- 
ance of  malignant  disease ;  but  a  little  reflection  enabled 
us  to  doubt  of  the  fact.  This  doubt  was  easily  resolved 
by  passing  the  probe  point  of  Simpson's  sound  along  and 
quite  through  the  lengthy  stricture,  into  the  free  and 
ample  vaginal  cavity  above.  That  this  was  done  was 
verified  by  an  examination  made  through  the  walls  of 
the  rectum,  in  doing  which  the  probe  point,  in  the  free 
cavity,  was  recognized,  as  well  as  the  shaft  of  the  sound 
lying  in  the  stricture,  and  closely  embraced  by  it.  The 
same  method  of  making  this  diagnosis  was  employed 
in  the  first  case  described  in  this  connection;  and  it  is 
one  always  to  be  resorted  to  and  relied  upon  with  im- 
plicit confidence. 

Having  stated  these  cases,  which  are  not  affections  of 
the  cervix  uteri,  we  hope  to  be  absolved  from  any  charge 
of  transcending  the  limits  assigned  to  us,  inasmuch  as 
we  have  deemed  it  proper  to  array  all  the  means  of 
differential  diagnosis  that  might  haply  serve  to  prevent 
misapprehension  in  the  cases  we  have  felt  charged  to 
treat  of,  and  shall  now  ask  liberty  to  refer  to  a  work 
entitled  "Woman,  her  Diseases  and  Remedies,"  page 
106,  for  the  history  of  a  case  whose  circumstances  are 
forcibly  recalled  to  memory  by  the  above  observations. 

Hitherto  we  have  not,  in  this  treatise,  said  anything 
in  regard  to  the  malignant  degenerations  of  the  texture, 
so  often  met  with  in  inquiring  into  diseases  of  the  neck 
of  the  uterus. 

To  dilate  upon  all  the  forms  of  malignant  chronic  or 
acute  diseases  of  the  cervix  would  require  a  considerable 


OF  THE  NECK  OF  THE  UTERUS.        83 

volume,  and  it  is  not  to  be  supposed  that  such  a  detail 
would  fail  to  exhaust  the  patience  of  the  reader.  The 
figure  (Plate  18),  which  we  have  in  this  connection  pre- 
sented, is  designed  to  illustrate  one  form,  of  chronic  dis- 
ease of  the  neck  of  the  womb,  which,  in  the  case  at 
least  from  which  the  figure  has  been  carefully  designed, 
was  found  susceptible  of  a  radical  cure. 

The  patient  was  a  very  robust  and  stout  married 
woman,  aged  about  30  years,  less  or  more.  She  had 
children.  Complaining  of  frequent  attacks  of  irregular 
menstrua,  she  appealed  for  advice  to  a  physician,  who, 
giving  an  unfavorable  prognosis,  so  excited  her  fears 
and  the  anxiety  of  her  family,  that  the  author  was 
invited  to  form  an  opinion  on  the  case. 

The  vagina  contained  a  substance  of  the  size  and 
shape  of  the  red  mass  which,  in  Plate  18,  is  seen  spring- 
ing from  the  anterior  aspect  of  the  vaginal  cervix.  To 
the  touch,  it  communicated  the  impression  always  pro- 
duced by  touching  the  tissues  in  scirrhus  or  carcinoma 
uteri.  It  had  the  same  resistance,  and  roughness  or 
grater-like  feel  that  belong  to  cancer  of  the  womb  or 
vagina.  The  gentlest  touch  caused  it  to  bleed.  It  was 
not  sensitive  so  as  to  be  intolerant  of  pressure. 

The  posterior  aspect  of  the  cervix  gave,  by  the  touch, 
the  idea  of  normal  tissue;  and  this  was  likewise  the 
case  as  to  both  the  lips  of  the  os  tineas ;  and,  indeed,  all 
the  accessible  parts  of  the  womb  seemed  to  be  perfectly 
sound  and  healthy,  save  only  where  the  peduncle,  or 
root  of  this  malignant  mass,  arose  from  the  anterior 
aspect  of  the  neck.      The  vagina  was  everywhere  quite 


84  ACUTE    AND    CHRONIC    DISEASES 

healthy.  An  inspection  of  the  figure  must  produce  the 
same  impressions  as  were  excited  in  the  author's  mind 
by  the  physical  diagnosis. 

It  would,  in  such  a  case,  evidently  be  useless  to  apply 
any  dressings  to  the  surface  of  the  tumor,  which  must 
be  supposed  to  be  all  of  one  quality  and  vital  temper, 
from  the  base  to  the  apex.  It  would  be  a  mere  waste 
of  time,  therefore,  to  act  upon  the  surface  of  it  only. 
But  if  the  diseased  mass,  in  fact,  proceeded  from  the 
base  alone,  on  which  it  rested  and  depended  for  its  ex- 
istence, then  one  might  hope  that,  in  eradicating  the 
very  base  itself,  would  be  found  a  sure  remedy  for  an 
otherwise  fatal  extension  of  the  degeneration. 

It  was,  accordingly,  proposed  that  the  mass  should  be 
removed,  either  with  a  uvula  scissors,  or  by  means  of  a 
ligature.  The  ligature  being  preferred,  was  applied,  and 
the  mass  came  away  after  a  few  days. 

It  was  also  proposed  that,  as  soon  as  the  tumor 
should  come  away,  the  base  or  root  should  be  destroyed 
by  actual  cautery,  or  by  acid  nitrate  of  mercury.  The 
latter  was  adopted.  Every  vestige  of  diseased  structure 
was  thus  removed,  and  the  lady  has  now,  for  three  years, 
enjoyed  good  health ;  having  experienced  very  little  in- 
convenience during  the  whole  process  of  cure. 

The  question  naturally  here  arises,  whether  this  was 
a  malignant  tumor  or  no.  We  are  aware  that  some 
persons  will  be  likely  to  regard  its  curability  as  evidence 
of  its  non-malignant  nature ;  but,  as  for  us,  we  consider 
that  such  a  mass,  being  left  to  work  out  its  own  com- 
plete development,  could  not  fail,  in  the  progress  of  it, 


1 

OF  THE  NECK  OF  THE  UTERUS.        85 

to  involve  in  destruction  larger  and  still  larger  portions 
of  the  uterine  tissue,  and  at  last  bring  the  life  of  the 
patient  to  a  premature  close.  If  the  tumor  was  not 
malignant,  it  would  become  so  if  left  uncured. 

It  would  have  been,  perhaps,  hopeless  to  attempt  the 
cure,  had  the  examination  not  given  the  most  flattering 
assurances  that  the  diseased  mass  sprung  from  a  rather 
superficial  portion  of  the  cervix,  as  was  ascertained  by 
the  touch.  We  doubt  not  that,  in  numerous  instances 
of  parts  wholly  changed  like  this,  cures  have  been  and 
will  be  effected  by  removing  all  changed  texture — ex- 
posing sound  surfaces,  which,  being  filled  by  healthy 
granulation,  restore  completely,  or  almost  completely, 
both  form  and  function  to  the  before  diseased  parts. 

We  shall  next  beg  leave  to  call  attention  to  a  form  of 
diseased  cervix,  of  which,  during  a  very  long  and  co- 
pious experience  in  practice,  we  have  met  with  but  one 
solitary  example.  And  even  this  is  rendered  less  use- 
ful, perhaps,  by  coincident  circumstances  of  the  patient, 
that  serve  to  lessen  the  value  of  the  case  as  furnishing 
experimental  results  of  the  treatment.  The  lady  was 
near  fifty  years  of  age,  had  borne  several  children,  but 
none  since  seven  or  eight  years.  She  was  in  an  ad- 
vanced stage  of  pulmonary  tuberculosis,  and  evidently 
destined,  at  an  early  day,  to  die  with  pulmonary  con- 
sumption. 

Certain  symptoms,  proceeding  from  intro-pelvic  dis- 
turbance, and  causing  great  distress,  led  to  the  opinion 
that  the  whole  case  was  aggravated  by  some  form  of 
uterine   irritation  ;    and  as  she  was   anxious  to  be  re- 


86  ACUTE    AND    CHRONIC    DISEASES 

lieved,  and  willing  to  undergo  an  examination,  it  was 
found,  on  making  one  by  the  touch,  that  the  vaginal 
neck  and  os  were  both  enlarged  and  painful.  The 
mouth  of  the  womb  was  much  more  patulous  than  it 
ought  to  be,  and  a  lump  was  perceived  upon  the  anterior 
aspect  of  the  chirurgical  neck.  On  exposing  the  point 
by  means  of  a  Recamier  tube,  there  was  seen  a  bright 
elastic  tumor  of  a  translucent  appearance,  which  is 
represented  in  Plate  19,  Fig.  2. 

The  lady,  even  in  her  low  state  of  health,  was  con- 
vinced that  she  was  pregnant ;  but  the  womb  could  not 
be  felt  through  the  hypogastric  integuments.  Whence 
it  was  inferred  that  the  organ  was  of  the  form  and 
dimensions  given  in  Plate  19,  Fig.  1. 

Professor  Mutter  opened  this  hygroma  with  a  sharp- 
pointed,  narrow  bistoury,  and  there  issued  from  it  a  few 
drops  of  colloid  fluid,  but  as  transparent  as  albumen  ovi; 
after  which  came  away  a  few  drops  of  blood,  whereupon 
the  tumor,  or  hygroma,  collapsed,  and  the  lady,  whose 
consumption  made  continual  progress,  had  little  or  no 
farther  trouble  from  this  special  cause ;  a  few  touches 
of  the  pencil  of  argent,  nitrat.  having  dissipated  the 
inflammation  and  engorgement  of  the  womb. 

A  few  months  later,  she  died,  exhausted  with  hectic 
— the  lungs  being  utterly  disorganized  by  softened  tuber- 
cles and  numerous  vomicse. 

A  post-mortem  examination  being  allowed,  it  was 
found  that  the  hygroma  had  not  filled  again,  but  left  a 
bluish  spot  or  blain.  The  os  was  still  a  good  deal  open, 
but  the  neck  was  little  enlarged.    Plate  19,  Fig.  1,  shows 


OF  THE  NECK  OF  THE  UTERUS.        87 

a  profile  view  of  this  uterus,  which  is  deemed  well 
worthy  of  observation,  particularly  because  the  fundus 
was  converted  into  a  tumor,  which  is  seen  like  a  sub- 
rotund  swelling  at  the  left  hand  end  of  the  figure,  and 
somewhat  separated  from  the  general  mass  of  the  uterus 
by  the  sort  of  strangulation  or  groove  seen  in  the  pic- 
ture. This  was  a  firm  fibrous  product,  developed  out  of 
the  substance  of  the  fundus  itself,  which  underwent  this 
fibrous  conversion,  while  every  other  part  of  the  organ 
retained  the  equable  ratios  of  its  several  elementary  or 
constituent  tissues. 

We  observed  that  we  deemed  this  case  interesting, 
and  it  is  so,  chiefly  in  this,  that  it  would  be  likely  to 
give  rise  to  a  false  diagnosis,  and  that  on  the  following 
accounts : — 

Leaving  out  of  consideration  the  tuberculosis,  which, 
it  was  manifest,  must,  at  no  distant  day,  destroy  the 
patient,  and  judging  only  from  the  results  of  the  pelvic 
examination,  and  the  inquiries  made  at  the  surpubal 
region,  one  would  be  led  to  pronounce  a  flattering  prog- 
nosis, since  one  would  scarcely  doubt  of  his  ability  to 
cure  all  the  evident  disorders  of  this  womb.  Yet,  no 
one  could  examine  the  necroscopic  specimen  without  at 
once  perceiving  that  it  would  be  impossible  to  cure  such 
a  womb  as  this.  The  apparent  fundus  is  not  the  fundus, 
in  fact,  but  is  a  fibrous  tumor,  into  which  parts  of  the 
true  fundus  have  been  converted.  It  is  inaccessible  to 
any  surgical  means,  and  is  wholly  disobedient  or  indiffer- 
ent to  every  therapeutical  force.  As  well  might  we 
administer  medicines  to  convert  a  femur  into  a  tibia, 


88  ACUTE    AND    CHRONIC    DISEASES 

and  vice  versa,  as  to  give  them  ip  convert  a  tumor  into 
a  natural  tissue  again.  The  attempt  is  ever  a  ridicu- 
lous one,  evincing  a  complete  misunderstanding  of  the 
laws  of  life,  as  well  as  of  the  scope  of  the  medical  art. 

A  swelling  may  be  cured  again ;  but  a  tumor  is  a 
new  product,  and  as  much  an  independent  organism  as  a 
lung,  an  eye,  or  a  muscle.  It  has,  however,  no  generical 
destiny ;  and,  therefore,  can  obey  no  therapeutical  law. 

Before  bringing  this  paper  to  a  close,  we  shall  present 
a  few  remarks  on  the  subject  of  displacement  of  the 
neck  of  the  womb ;  and  we  begin  by  referring  to  our 
Plate  3,  to  show  the  due  relations,  as  to  distance,  of  the 
os  tincce  from  the  walls  of  the  pelvis. 

The  ligamenta  utero-sacralia,  so  called  by  the  anato- 
mists, appear  to  us  to  be  rather  deserving  the  denomina- 
tion ligamenta  vagino-sacralia ;  for  they  are  in  reality 
duplicatures  of  peritoneum  running  backwards,  one  on 
each  side  of  the  pelvis,  from  the  posterior  or  upper 
extremity  of  the  vagina  to  the  sacrum.  It  seems  to  us 
that  their  office  is  to  keep  the  end  of  the  vagina  at  a 
certain  place,  near  enough  to  the  lower  part  of  the  sa- 
crum ;  and  certain  it  is  that,  as  long  as  they  preserve 
their  due  firmness  or  tension,  the  upper  end  of  the 
vagina  cannot  drop  down  from  near  the  sacrum  to  near 
the  arch  of  the  pubis.  A  line  drawn  from  the  lower 
part  of  the  sacrum,  say  near  its  fourth  segment,  to  the 
top  of  the  arch,  is  at  least  four  and  a  half  inches.  When 
we  find  the  os  tincaB  jutting  outside  of  the  arch,  we 
know  that  the  vagina  has  fallen  at  least  three  and  a 
half  inches,  and  of  course  that  the  ligamenta  utero-sacra- 


OF  THE  NECK  OF  THE  UTERUS.        89 

lia  are  stretched  or  elongated  to  that  amount.  But 
when,  on  making  such  an  examination,  we  thrust  or 
carry  the  cervix  uteri  backwards  and  upwards  to  its  true 
place,  then  the  ligamenta  utero-sacralia  become  again  as 
short  as  they  ought  to  be;  and  if  they  would  remain 
permanently  so,  we  should  cure  the  patient  merely  by 
thus  thrusting  the  uterus  up  to  its  true  place.  But,  un- 
fortunately, when  we  take  away  the  support,  it  falls 
down  again ;  because  the  utero-sacral  folds,  and  all  the 
serous  and  cellular  or  areolar  relations  of  the  vagina  are 
weak  and  relaxed,  and  cannot  hold  it  up. 

Now,  if  this  be  a  just  representation  of  the  facts,  no 
one  can  deny  that  prolapsus  uteri  is  a  disorder  or  weak- 
ness of  the  vagina  and  its  ligaments,  and  that  to  cure 
the  prolapsus  we  must  cure  the  vagina  first ;  it  being 
evident  that,  with  a  vagina  of  three  and  a  half  inches 
in  length,  the  womb  cannot  quit  its  place  in  the  pelvis. 

The  womb,  as  we  have  already  said,  is  two  and  a 
quarter  inches  in  length,  and  the  longest  antero-pos- 
terior  plane  within  the  pelvis  may  be  assumed  to  be 
four  inches  and  a  half.  Hence,  it  is  clear  that,  if  the 
womb  be  thrown  over  backwards,  so  as  to  let  its  fundus 
fall  into  the  rectovaginal  cul-de-sac  of  peritoneum,  called 
the  Douglass  cul-de-sac,  it  is  inevitable  for  the  cervix 
uteri  to  come  forward ;  for  the  uterus  cannot  well  turn 
over  without  a  see-saw  movement.  If,  therefore,  the 
womb  preserve  its  rigidity,  and  it  be  retroverted,  the  os 
tineas  must  come  near  to  the  symphysis  pubis.  This 
would  be  the  case  in  all  instances  of  retroversion  with- 
out flexion  of  the  longitudinal  axis  of  the  uterus.     We 


90  ACUTE    AND    CHRONIC    DISEASES 

have  met,  in  practice,  with  many  instances  of  this  kind, 
and  in  more  than  one  remarkable  case  have  found  the 
fundus  fastened  down  in  its  unnatural  bed  in  the  pelvis, 
by  means  of  strong  adhesions,  which  it  was  necessary 
to  divide  with  the  scalpel  before  we  could  reduce  the 
uterus  into  its  proper  position  again.  One  was  a  case  of 
retroversion,  with  hypertrophy  of  the  womb  coinciding 
with  fatal  Fallopian  pregnancy.  The  organ  stretched 
across  the  pelvis,  from  the  sacrum  to  the  pubis,  fully 
four  and  a  half  inches.  The  specimen  is  in  our  collec- 
tion.    Another  was  a  case  of  uterine  pregnancy. 

But,  while  it  is  true  that  the  uterus,  being  of  a  rigid 
and  firm  consistence,  does  not  always  bend  in  retrover- 
sion, it  is  very  common  to  meet  with  specimens  in 
which  the  organ  is  bent  at  a  right  angle,  or  even  more 
than  that.     Retroversion,  with  an  unbent  womb,  is  a 

Fig.    3. 


mere  accident  or  chirurgical  disorder ;  whereas  retrover- 
sion, with  a  bent  or  angulated  uterus,  is  a  case  in  which 
the  womb  has  itself  become  diseased.     It  is  a  case  in 


OF  THE  NECK  OF  THE  UTERUS.        91 

which,  by  the  nutrition  of  one  segment  or  half  of  the 
womb,  it  has  grown  smaller  or  larger  than  the  other 
symmetrical  half  or  segment ;  for,  it  is  clear,  if  both  the 
anterior  and  posterior  halves  should  grow  or  be  de- 
veloped pari  passu,  the  organ  could  be  only  straight, 
and  could  be  by  no  means  crooked  or  bent,  as  in  the 
above  diagram.  The  quantity  of  the  convex  must  greatly 
exceed  the  quantity  of  the  concave  half;  otherwise,  the 
womb  could  not  be  bent,  but  must  remain  straight  or 
fusiform. 

In  treating  these  retroversions,  therefore,  we  must 
expect  to  meet  with  greater  difficulty  and  delay  in  the 
case,  if  we  have  an  angulated  organ  to  rectify,  as  well 
as  a  case  of  retroversion.  We  do  not  mean  to  say  that 
the  methods  are  different,  since  there  is  but  one  good 
method  for  all  of  them,  and  that  is  a  treatment  by  the 
pessarium  of  a  proper  form. 

And  here  we  may  beg  leave  to  notice  what  we  regard 
as  a  great  oversight  on  the  part  of  practitioners,  in  re- 
gard to  one  of  the  chiefest  sources  of  embarrassment  and 
ultimate  disappointment  of  the  cure.  The  circum- 
stance here  alluded  to  is  this.  In  retroversions  of  some 
considerable  duration,  the  anterior  column  a  of  the  va- 
gina has  become  shortened,  and,  in  consequence  of 
its  being  without  any  antagonistic  or  opposing  force, 
allowed  so  to  coacervate  its  material  as  to  be  indisposed 
afterwards  to  remain  in  the  state  of  extension  natural 
to  it. 

We  believe  that  all  living  soft  parts  have  an  inde- 
feasible tendency  to  consolidation,  when  not  prevented 


92  ACUTE    AND    CHRONIC    DISEASES 

by  an  antagonizing  power.  This  depends,  indeed,  on 
what  Bichat  announces  as  the  contractility  par  defaut 
d extension.  If  the  os  uteri  should  be  brought  close  to 
the  symphysis  pubis,  and  kept  there  for  some  months 
or  years,  it  is  clear  that  if  any  one  should  cause  it  to 
remove  backwards  again  to  its  place  three  and  a  half 
inches  away  from  the  crown  of  the  arch,  and  then  let  it 
go,  it  would  leap  back  again  to  the  vicinity  of  the  pubis, 
being  drawn  thither  by  the  anterior  column  of  the 
vagina,  which  soon  contracts  again  like  a  bit  of  stretched 
caoutchouc.  Now,  this  is  the  circumstance  which  we 
complained  of  as  being  too  much  overlooked  by  our 
physicians  in  their  intentions  as  to  a  cure.  They  are 
well  enough  aware  that  when  the  womb  is  overset,  or 
retroverted,  it  is  useless  to  reposit  it,  and  then  abandon 
it  to  itself,  since  it  always  falls  over  again  with  the  first 
motion,  or  effort  to  stoop,  or  to  cough,  &c.  They  have 
used  pessaries  of  every  possible  shape,  and  they  have 
been  much  annoyed  to  find  their  patients  worse  instead 
of  being  better  for  their  use. 

An  immense  use  has  been  made  of  the  globe-pessary; 
and  certainly,  in  a  simple  prolapsus  uteri,  it  answers 
admirably.  But  it  does  not  answer  well  for  the  cases  of 
retroversion;  because  the  morbidly  condensed  and  elastic 
anterior  columna  of  the  vagina,  slowly  contracting  in 
order  to  recover  a  state  of  rest,  pulls  the  os  uteri  for- 
wards over  and  above  the  convex  upper  surface  of  the 
ball,  and  draws  it  again  close  up  to  the  symphysis,  the 
fundus  meanwhile  sinking  down  backwards  into  the 
peritoneal  cul-de-sac  between  the  rectum  and  the  vagina. 


OF  THE  NECK  OF  THE  UTERUS.        93 

In  this  case,  the  woman  is  greatly  annoyed,  having  both 
a  pessary  and  a  retroversion  to  contend  with. 

Many  years  ago,  the  author  was  in  attendance  on  an 
aged  woman,  who  had  long  suffered  from  prolapsus 
uteri.  She  had  been  taught,  by  a  nurse,  to  construct  a 
pessary,  by  making  a  whalebone  ring,  some  three  inches 
in  diameter.  This  ring  being  wrapped  or  served  with 
bobbin,  was  dipped  in  melted  wax,  until  a  sufficient 
coating  of  wax  was  given.  In  this  way  she  made  an 
elastic  annular  pessary,  by  means  of  which  she  was 
enabled  to  pass  through  many  years  of  an  advanced  age, 
without  any  inconvenience  from  a  procidentia  which 
always  threatened  to  return  upon  the  removal  of  the 
support. 

The  globe-pessary  of  Dr.  Physick,  and  the  concavo- 
convex  disk,  or  Dewees's  pessary,  have  been  much  em- 
ployed in  Philadelphia,  and  throughout  the  United 
States  generally,  as  might  be  expected  from  the  eminent 
position  and  repute  of  both  those  gentlemen. 

The  globe  of  Dr.  Physick  is  liable  to  the  objection 
above  stated,  as  a  remedy  for  retroversion ;  and  Dewees's 
disk  is  equally  obnoxious  to  criticism,  as  being  liable  to 
injure  the  os  uteri,  which  rests  nearly  vertically  upon 
the  metallic  surface.  Of  course,  the  same  objections  lie 
against  all  the  glass-pessaries,  of  which  many  thousands 
have  been  on  sale  in  the  drug  establishments  of  our 
people.  Indeed,  they  are  at  last  becoming  justly  dis- 
credited. 

Seeing  the  difficulties  that  surround  this  subject,  and 
acting  on  the  experience  of  the  aged  lady  already  men- 


94 


ACUTE    AND    CHRONIC    DISEASES 


tioned,  the   author   constructed   pessaries  with   watch- 
spring,  as  follows : — 

Take  a  piece  of  watch-spring  of  the  proper  length. 
That  is  to  say,  if  a  pessary  of  three  inches  diameter  is 
required,  take  a  lamina  of  watch-spring  nine  inches  and 
three-sixteenths  in  length.  Bend  it  into  a  circle,  and 
rivet  or  solder  it,  to  make  an  annul  us  three  inches 
in  diameter.  Serve  it  all  round  with  bobbin,  or  large 
twine,  and  then  dip  it  again  and  again  in  melted  virgin 
wax,  so  as  to  infiltrate  the  threads  completely.  Polish 
the  waxen  surface  with  the  hands.    This  ring,  which  is 


Fig.  4. 


as  elastic  as  watch-spring,  can   be  compressed  betwixt 
the  thumb  and  fingers,  so  as  to  be  converted  from  the 


OF    THE    NECK    OF    THE    UTERUS, 


95 


shape  of  this  figure  (4)  to  that  of  Fig.  5,  and  then  intro- 
duced into  the  vagina  without  giving  the  woman  any 
pain.  As  soon  as  it  has  taken  its  place,  it  expands 
again,  and  recovers  its  original  form. 

Previous  to  introducing  the  annulus,  the  womb  should 
be  reposited,  either  by  the  hand  alone  or  by  Professor 
Simpson's  womb-sound ;  and,  that  being  done,  the  annulus 
acts  in  the  manner  illustrated  by  Plate  20,  in  which  a 
silver  ring,  gilt,  is  made  use  of. 


Fig;.   5. 


Let  it  be  observed  that  the  distance  from  the  pubis  to 
the  sacrum,  in  this  plane,  is  at  least  four  inches  and  a 
half,  and  that  the  annulus  is  three  inches  in  diameter. 


96  ACUTE    AND    CHRONIC    DISEASES 

Now,  if  the  ring  is  introduced  in  such  a  manner  as  to 
cause  the  sacral  segment  of  it  to  pass  behind  the  cervix, 
and  rest  in  the  cul-de-sac  behind,  formed  by  the  poste- 
rior columna  of  the  vagina,  while  the  pubal  or  anterior 
segment  rests  on  the  symphysis  pubis,  it  is  impossi- 
ble that  the  cervix  uteri  should  again  come  forward  to 
the  symphysis,  or  that  the  retroversion  can  occur  again 
while  the  annulus  is  left  in  situ  to  prevent  it.  Indeed, 
the  vagina  is  now  full  three  inches  in  length,  and  not 
even  prolapsus  uteri  can  vex  the  patient ;  for  prolapsus 
is  shortening  of  the  vagina,  and  nothing  more  and 
nothing  less. 

Such  an  annular  pessary  as  this,  left  in  situ  for  a  few 
months,  must  effectually  overcome  the  contraction  par 
defaut  d' extension  of  the  anterior  vaginal  column ;  and 
by  allowing  the  ligamenta  utero-sacralia  to  be  at  long 
rest,  they,  by  coacervation  of  their  substance,  will  re- 
cover their  normal  density  or  tone ;  and  so,  the  ring 
being  at  last  taken  away,  the  woman  is  found  to  be 
cured ;  for  the  ligam.  utero-sacralia  are  now  condensed 
again,  and  the  anterior  columna  vaginalis  has  regained 
its  ductility. 

The  method  of  constructing  annular  pessaries  of 
watch-spring,  as  above  set  forth,  was  detailed  at  a  meet- 
ing of  the  College  of  Physicians  of  Philadelphia,  by  the 
reporter. 

At  a  subsequent  meeting  of  that  College,  one  of  the 
Fellows  thereof,  Dr.  Charles  Evans,  reported  an  im- 
provement, consisting  in  coating  the  watch-spring- 
served  annules  with  gutta  percha  dissolved  in  chloro- 


OF  THE  NECK  OF  THE  UTERUS.        97 

form ;  and  this  fortunate  idea  has  rendered  the  instru- 
ment so  perfect,  that  we  may  suppose  it  to  be  all  that 
could  be  wished  for  as  an  apparatus  for  the  purpose  of 
treating  retroversions. 

Reporter  has  long  used  annules  made  of  absolutely 
pure  silver  cylinders,  bent  into  a  circle  and  gilt  with 
fire  gilding.  Such  an  instrument  is  excellent,  and  is  so 
pliable  that  it  may  be  crushed  into  an  elliptical  form 
before  its  introduction,  and  then,  by  a  little  dexterity, 
opened  again  into  the  circular  form  while  lying  within 
the  vagina.  This  is  perhaps  the  most  perfect  of  these 
instruments,  yet  difficult  to  use  and  to  obtain. 

A  reference  to  Plate  20  shows  that,  if  the  posterior 
segment  of  such  an  annulus  is  lodged  within  the  cul-de- 
sac  of  the  vagina  that  is  found  behind  the  neck  of  the 
womb,  while  the  anterior  segment  reposes  upon  the 
tissues  just  above  and  behind  the  crown  of  the  pubal 
arch,  it  is  absolutely  impossible  for  the  retroversion  to 
take  place ;  and  it  is  to  be  believed  that,  in  a  space  of 
time,  greater  or  less,  according  to  a  variety  of  circum- 
stances, all  the  tissues  concerned  in  keeping  the  uterus 
in  its  place  will  recover  their  tone,  by  virtue  of  the  phy- 
siological force  called  by  Bichat  contractilite  par  defaut 
$  extension.  It  could  not  be  otherwise.  As  to  the  ex- 
ternal apparatus  called  utero-abdominal  supporters, 
which  we  have  the  mortification  to  see  prescribed  and 
applauded  by  physicians  and  surgeons,  even  eminent 
persons  in  our  class,  we  can  but  express  again  our  con- 
viction of  their  utter  uselessness,  as  well  as  the  liability 
7 


98  ACUTE    AND    CHRONIC    DISEASES 

of  those  who  use  them  to  aggravation  of  all  the  evils  for 
which  they  are  the  pretended  remedies. 

We  have  here  placed  a  drawing  (Plate  21),  taken 
from  the  museum  of  Jefferson  Medical  College,  at  Phila- 
delphia, which  represents  one  of  the  specimens  there  of 
polypus  of  the  womb ;  and  we  have  felt  constrained  to 
present  some  remarks  upon  cases  of  this  kind,  inasmuch 
as  they  greatly  interest  the  cervix  of  the  uterus,  whose 
acute  and  chronic  diseases  we  are  commanded  to  de- 
scribe. And  herein  we  do  not  feel  called  upon  to  go 
into  a  full  account  of  the  various  uterine  polypi.  Let  it 
suffice  to  say  that  they  consist  of  tumors,  hard  or  soft, 
which  rise  up  from  the  surface,  whether  exterior  or 
interior,  of  the  child-bearing  organ :  many  of  them, 
however,  being  developed  in  the  very  substance  of  the 
organ,  and  invading  greater  or  lesser  portions  of  its 
structure. 

These  growing  polypi  depend  upon  non-equable  de- 
velopment of  certain  of  the  elementary  tissues  of  the 
womb,  which,  being  produced  out  of  all  normal  rate, 
may  attain  a  great  magnitude  or  mass.  They  vary 
from  a  few  grains  in  weight,  like  the  currant-shaped  ex- 
crescence in  Plate  16,  Fig.  1,  or  the  bunches  in  Plate  16, 
Fig.  2,  or  the  more  considerable  tumor  projecting  from 
the  os,  in  Plate  21.  We  possess  specimens  of  the  size 
of  an  ostrich  egg,  and  one  that  was  at  least  six  inches 
in  longitudinal  by  five  in  the  conjugate  diameter.  We 
were  present  at  the  examination  of  a  specimen,  which 
was,  at  the  time,  weighed  by  the  late  Professor  Wm.  E. 
Horner,  and  found,  with  the  womb  which  contained  it, 


OF  THE  NECK  OF  THE  UTERUS.        99 

to  weigh  thirty-two  pounds.  The  degenerated  develop- 
ment-force, by  means  of  which  a  fibrous  polypus  rises 
up  on  the  surface  of  the  womb,  or  within  its  substance, 
may,  in  some  cases,  extend  so  far  throughout  the  whole 
limits  of  the  uterus  as  to  apparently  convert  the  whole 
substance  of  it  into  the  material  or  nature  of  polypus. 
We  possess  a  specimen,  in  which  it  would  be  difficult  to 
discriminate  between  the  character  of  the  large  mass, 
into  which  the  whole  womb  has  become  converted,  and 
the  substance  of  the  large  polypi  just  now  mentioned  as 
in  our  possession. 

But  lest  we  should  be  tempted  to  carry  this  investiga- 
tion far  beyond  the  limits  proper  for  this  paper,  we 
shall  confine  ourselves  to  remarks  upon  the  interior 
polypus,  or  polypus  of  the  cavity  of  the  womb. 

A  tumor  of  this  sort,  which,  at  the  commencement, 
might  be  supposed  to  be  no  bigger  than  a  split  pea, 
growing,  by  constant  nutrition  of  its  mass,  soon  comes 
to  distend  the  cavity  which  it  occupies,  and  that  cavity 
must  expand  upon  the  same  principles  as  those  which 
regulate  the  physiological  hypertrophization  or  evolu- 
tion of  the  womb  in  true  pregnancy.  If  the  polypus 
should  take  its  origin  within  the  true  cavity  of  the 
uterus,  the  fundus  and  corpus  uteri  would,  of  course, 
first  expand  for  the  accommodation  of  the  growing 
mass,  just  as  happens  in  the  early  stages  of  a  gestation. 

Under  these  circumstances,  the  form  and  size  of  the 
neck  of  the  womb  do  not  undergo  any  change,  and  an 
examination  per  vaginam  would  not  enable  a  physician 


100  ACUTE    AND    CHRONIC    DISEASES 

to  pronounce  with  assurance  that  any  change  whatever 
had  taken  place  in  the  form  and  volume  of  the  organ. 

The  term  expansion  does  not  here  imply  merely  a 
stretching  of  the  walls — as  when  a  bladder  is  blown,  but 
it  means  a  regular  physiological  hypertrophy,  or  growth. 
Now,  when  the  womb  grows,  it  must  grow  generically, 
and  will,  in  such  case,  preserve  its  generical  character 
as  to  form ;  for  the  idea  of  genus  and  species  cannot  but 
include  ideas  of  both  form  and  substance,  of  superficies 
and  solid  contents;  when  the  womb,  or  parts  of  it  dege- 
nerate, then  the  form  goes  in  the  most  convenient  direc- 
tion, or  qua  data  porta. 

A  great  uncertainty  as  to  the  existence  or  non-exist- 
ence of  pregnancy  ever  attends  the  vaginal  examination 
in  the  early  stages;  but  in  proportion  as  a  polypus 
or  an  ovum  becomes  larger,  so  must  the  cervical  por- 
tion of  the  womb  grow  shorter,  until,  at  last,  the  cylin- 
droidal  neck  acquires  the  shape  of  a  cone,  or  rather  a 
conoidal  form ;  for  a  polypus,  though  it  can  grow  indefi- 
nitely, and  come  to  be  of  an  enormous  size  at  last,  must 
ever  mould  itself  upon  the  internal  walls  of  the  womb. 
The  polypus,  therefore,  cannot  so  alter  the  shape  of  the 
womb  as  to  give  it  a  figure  other  than  such  as  naturally 
belongs  to  it,  and  characterizes  it  whether  gravid  or  not 
gravid. 

Sooner  or  later,  in  any  case  of  polypus  uteri,  it  may 
be  expected  that  the  lower  segment  of  the  tumor  shall 
appear  at  the  os  uteri,  and  gradually  dilating  it  more 
and  more,  open  it  at  last  so  widely  that  the  contractility 


OF  THE  NECK  OF  THE  UTERUS.       101 

of  the  fundus    and   body  shall  be   able  to   thrust   the 
tumor  out  into  the  vagina. 

In  the  figure  (Plate  21)  it  is  seen  that  the  polypus 
begins  to  show  itself  very  plainly  at  the  opening  mouth 
of  the  womb.  But,  with  the  cone  of  the  cervix,  and  the 
circle  of  the  os  so  thick  and  strong  as  here  shown,  it 
could  not  be  that  the  polypus  shall  very  soon  be  ex- 
pelled from  the  uterine  cavity. 

It  might  be  a  question  whether  the  diagnosis  of  such 
a  tumor  is  to  be  absolutely  relied  upon,  seeing  that  it  so 
closely  resembles  the  case  of  haaniatoma  or  bleeding 
fungus,  represented  at  Plate  15  of  this  report.  Yet  it  is 
not  difficult,  either  with  the  index  finger  alone  or  with 
a  womb-sound,  to  ascertain  that  the  fungus  at  Plate  15 
is  a  hematoma  springing  directly  from  the  inner  wall  of 
the  canalis  cervicis,  while  the  other  tumor  (Plate  21) 
is  a  real  uterine  polypus  rising  from  a  portion  of  the 
wall  of  the  true  cavity.  I  may  repeat  that  the 
shape  assumed  by  the  womb  in  a  natural  pregnancy 
is  well  known ;  and  that  in  all  cases  where  the  womb 
contains  a  true  polypus  of  the  cavity,  it  in  like  manner 
preserves  its  natural  form.  But,  if  a  fibrous  or  other 
degeneration  within  its  texture  takes  place  in  the  very 
substance  or  walls  of  the  womb,  making  one  or  many 
fibrous  tumors,  the  womb  loses  its  normal  form,  and 
becomes  lumpy  or  botryoidal. 

The  examination  of  such  cases  should,  hence,  always 
be  so  conducted  as  to  lead  to  a  knowledge  of  the  form 
actually  possessed  by  the  enlarged  organ.  If  that  form 
be  normal,  or  generical,  then  we  infer  that  the  enlarge- 


102  ACUTE  AND   CHRONIC    DISEASES 

ment  is  occasioned  by  the  presence  of  something 
moulded  into  shape  by  the  womb  itself,  and  that  it  is 
an  ovum  or  a  polypus.  If,  on  the  other  hand,  the 
generical  form  is  not  preserved,  we  may  infer  the  exist- 
ence of  some  morbid  growth  outside  of  the  cavity,  but 
within  the  very  substance  or  walls  of  the  womb. 

The  uterus  is  destined,  normally,  to  discharge  a 
quantity  of  blood  from  its  cavity  with  every  periodical 
ovulation,  and  the  custom  of  women  is  one  so  regularly 
observed,  that  it  gives  to  the  mind  a  tendency  to  regard 
every  discharge  of  blood  from  the  organ  as  a  menstrual 
discharge.  Hence,  when  women  find  themselves  bleed- 
ing too  often,  too  copiously,  or  in  a  way  too  greatly  pro- 
longed, it  is  their  habit  to  consider  the  deviation  as  a 
fault  of  their  courses.  They  do  not,  in  general,  consider 
that  blood  may  issue  from  such  a  sanguine  organ,  with- 
out the  discharge  having  any  relation  whatever  to  their 
mensual  act ;  and  they  usually  speak  of  all  such  preflu- 
via  as  disorders  of  the  menstruation.  A  medical  man, 
on  the  contrary,  ought  to  possess  an  ideal  standard,  by 
which  to  compare  every  such  case,  and  he  must  at  once 
perceive  that  such  a  state  cannot  possibly  be  a  men- 
sual state,  but  must  be  related  to  some  other  quality 
and  faculty  than  those  of  ovulation  and  menstruation. 

Enough  has  been  already  said  in  this  work  to  show 
that  morbid  changes  in  the  corpus  mucosum  of  the 
womb  may  serve  to  explain  the  frequent  reappearance 
of  sanguine  discharges  from  the  genitalia.  Such  dis- 
charges as  these,  however,  are  not  for  the  most  part 
copious  and  wasting.     It  is  true,  however,  that  such 


OF  THE  NECK  OF  THE  UTERUS.       103 

discharges  are  most  apt  to  coincide  with  the  hyperaemia 
of  the  ovulation,  or  to  have  relation  to  some  mental  or 
physical  shock,  or  to  the  sexual  insult,  &c.  &c. 

In  cases  like  that  portrayed  at  Plate  21,  the  proflu- 
vium  of  blood  is  likely  to  be  independent  of  any  perio- 
dical ovulation,  and,  indeed,  in  some  instances,  is  never 
wholly  absent,  while  the  subject  of  it  is  liable  to  sudden 
enormous  effusions  of  blood,  generally  greatest  at  the 
mensual  periods.  "We  have  elsewhere  related  a  case,  in 
which  the  woman  was  never,  during  six  years  and  a 
half,  without  bloody  issue  from  the  genitalia ;  an  issue 
which  arose  from  a  polypus  passed  into  the  vagina.  So 
many  striking  instances  of  this  either  frequent  or  con- 
stant hemorrhage  have  occurred  to  us  in  practice,  that 
we  spontaneously,  as  it  were,  adopt  it  as  prima  facie 
evidence  of  the  presence  of  a  uterine  polypus,  when  we 
discover  such  frequent,  or  copious,  or  constant  sanguine 
evacuations. 

A  polypus,  like  that  in  Plate  21,  whose  lower  seg- 
ment peeps  out  from  the  opening  os,  and  whose  sides 
are  compressed  or  strictured  by  the  firm  walls  of  the 
cervix  uteri,  could  hardly  do  otherwise  than  bleed  more 
or  less  day  and  night,  since  the  stricturing  cervix  must 
necessarily  keep  up  a  molimen  hgemorrhagicum  in  the 
uncovered  and  uncompressed  superficies  of  the  tumor. 

It  is  not  always,  however,  the  polypus  alone  that  has 
begun  to  project  beyond  the  stricturing  circle  of  the  os 
that  bleeds.  Many  wombs  are  kept  in  a  state  of  hy- 
peraemia and  hemorrhagica!  fulness  by  the  presence  and 


104  ACUTE   AND   CHRONIC    DISEASES 

pressure  of  the  polypus,  and  such  cases  are  marked  by 
the  most  violent  floodings.  Now,  when  we  come  to 
inquire  diagnostically  into  such  cases,  and  find,  upon 
touching,  that  the  os  tincse  is  unmodified,  and  the  cylin- 
drical neck  unchanged,  all  that  we  can  do  is  to  infer,  for 
we  cannot  know,  that  the  hemorrhages  are  caused  by  a 
polypus  in  the  cavity,  whose  existence,  however,  we  can 
only  conjecture  or  infer ;  and  especially  where  the  poly- 
pus is  still  so  small  as  not  greatly  to  magnify  the  womb 
and  make  its  increase  perceptible,  to  the  touch,  in  the 
surpubal  region. 

There  can  scarcely  be  found,  in  the  whole  range  of 
medical  duties,  a  more  difficult  case  of  diagnosis  than 
this.  Time  alone  can  solve  the  problem;  and  then 
only  by  protruding  the  mass  into  the  cervix,  or  out  into 
the  vagina,  whereupon  all  doubt  is  at  an  end. 

In  numerous  instances,  our  inferential  diagnosis  has 
been  verified  by  immediate  examination,  or  by  after 
events.  Yet  we  have  met  with  samples  of  such  hemor- 
rhage impressing  us  with  a  sort  of  inward  conviction 
that  they  could  only  arise  from  polypus,  a  conviction 
which  proved  to  be  a  baseless  hypothesis,  destitute  of 
any  foundation  of  truth. 

We  have  dwelt  thus  long  on  this  subject,  chiefly  out 
of  an  anxious  desire  to  put  our  friends  and  brethren  on 
guard  against  making  too  hurried  a  diagnosis,  and  also 
as  a  preface  to  the  drawing,  Plate  22. 

The  annexed  figure,  Plate  22,  was  drawn  from  the 
specimen  at  the  time  a  jpost-mortem  examination  was 


OF  THE  NECK  OF  THE  UTERUS.       105 

made  to  ascertain  the  cause  of  a  fatal  uterine  hemor- 
rhage. 

The  woman,  several  years  married,  had  borne  no 
children.  During  two  or  three  years,  she  had  been 
under  the  medical  care  of  the  author,  who,  observing 
her  to  be  occasionally  seized  with  frightful  uterine 
hemorrhages  that  left  her  always  excessively  hydrsemi- 
cal,  could  not  avoid  the  conclusion  that  a  small  polypus 
concealed  within  the  cavity  of  the  womb,  but  undiscern- 
ible  by  any  physical  examination,  would  at  some  future 
time  be  thrust  out  into  the  vagina,  so  as  to  allow  of  its 
removal.  Repeated  careful  examination  left  the  same 
impression  upon  the  mind. 

Meanwhile,  when  the  floodings  should  be  too  wast- 
ing, she  was  advised  to  resort  to  rest,  to  haemostatics, 
and,  above  all,  to  the  tampon  for  the  vagina. 

Having  removed  her  residence  to  a  greater  distance, 
she  took  counsel  of  another  physician,  and  for  more 
than  a  year  occasionally  suffered  from  attacks  of  very 
alarming  floodings.  Upon  the  last  of  these  occasions, 
the  writer  was  called  in  consultation  with  the  attending 
physician,  and,  hastening  to  the  rendezvous,  found  she 
had  expired  some  four  or  five  minutes  before  he  arrived. 
It  was  with  him  and  the  attending  physician  anxiously 
desired,  that  the  question  of  the  existence,  or  non-ex- 
istence, of  a  polypus  uteri  should,  in  this  case,  be  set- 
tled, and  the  figure  (Plate  22)  exhibits  a  very  correct 
view  of  the  cavity  and  walls  of  the  womb.  There  was 
nothing  upon  the  lining  membrane  that  should  throw 
any  light  upon  the  strange  and  most  obstinate  hemor- 


106  ACUTE    AND    CHRONIC    DISEASES 

rhages,  unless,  indeed,  the  magnitude  of  the  cavity  be 
so  regarded;  and  its  size  is  truly  given,  and  may  be 
compared  with  our  figure,  Plate  2,  Fig.  2.  But,  upon 
the  left  ovary  was  a  cystica!  tumor,  which  is  shown  in 
the  figure.  Yet  no  one  can  assign  such  a  cyst  as  a  suf- 
ficient cause  for  those  irregular  and  enormous  uterine 
evacuations. 

I  have,  at  this  moment,  under  treatment  the  case  of  a 
maiden  lady,  about  forty-three  years  of  age,  in  whom 
the  hemorrhages  are  immense  and  irregular — sometimes 
very  alarming.  In  this  instance,  I  can  by  no  means 
detect  any,  the  least,  modification  of  the  form,  size,  re- 
sistance, or  natural  place  of  the  womb ;  and,  it  is  proba- 
ble that  no  man  can  say  whether  these  distressing 
attacks  arise  from  polypus,  or  no. 

It  would  be  a  most  useful  thing  to  possess  some  cer- 
tain methods  by  which  to  distinguish  between  habitual 
violent  floodings  without  polypus  uteri,  and  cases  in 
which  the  polypus  does  exist,  but  cannot  be  come  at. 
One  can  scarcely,  in  medical  practice,  be  put  to  greater 
loss  for  some  certainty  in  discrimination,  than  in  such 
cases  as  these. 

The  great  length  of  this  paper  renders  it  necessary  to 
bring  it  to  a  close.  There  is  a  considerable  number  of 
affections  to  which  the  cervix  uteri  is  liable,  which  it 
would  be  easy  to  discuss ;  and,  in  regard  to  the  so-called 
malignant  disorders  of  the  part,  it  would  be  gratifying 
to  us  to  describe  and  illustrate  their  various  appear- 
ances, and  suggest  methods  for  their  treatment.  But 
we  refrain  from  farther   trespass  on  the  time  of  the 


OF  THE  NECK  OF  THE  UTERUS.       107 

reader,  to  whom  we  offer  the  foregoing  observations,  in 
the  hope  that  they  may  serve  to  remove  some  of  the 
difficulties  which  we  have  noticed  to  exist  in  the  path 
of  the  practitioner,  not  only  in  our  own  earlier  days  of 
observation,  but  now,  and  daily,  in  the  numerous  cases 
submitted  under  advice  for  our  revision  and  counsel.  If 
what  has  been  presented  is  at  once  true  and  clear,  we 
shall  indulge  the  hope  hereafter  to  have  fewer  calls  from 
persons  residing  in  distant  States. 

In  closing  this  essay,  the  Author  takes  the  occasion 
to  renew  the  expression  of  his  sincere  desire  that  the 
class  of  cases  herein  treated  of  may  receive  a  greater 
share  of  attention  from  his  brethren  in  the  practice  ;  so 
that  they  may  less  frequently,  than  heretofore,  be  found 
to  accumulate  in  the  large  cities  and  towns,  or  in  the 
hands  of  specialists :  he  is  convinced  that,  as  such  dis- 
orders require  no  greater  amount  of  particular  informa- 
tion or  dexterity  than  other  surgical  and  constitutional 
maladies,  it  is  within  the  ability,  and  is  the  duty  of  the 
brethren  generally,  to  conduct  them  safely  and  gently 
to  a  satisfactory  cure.  In  our  opinion,  it  would  be 
much  more  creditable  that  such  skill  and  discrimination 
should  belong  generally  to  the  whole  profession,  than 
for  one  or  two  individuals  in  a  district,  or  in  a  great 
metropolis,  as  London  or  Paris,  to  acquire  a  notoriety, 
which,  to  say  the  least  of  it,  is  scarcely  enviable ;  since, 
among  the  humiliating  services  that  physicians  and 
surgeons  are  by  their  vocation  obliged  to  render  to  the 
distressed,  none  can  be  more  revolting  to  the  sensitive 
mind  than  these. 


108      DISEASES    OF    THE    NECK    OF    THE    UTERUS. 

It  might,  perhaps  with  consoling  truth,  be  added, 
that  few  professional  ministrations  turn  aside  with 
greater  certainty  and  celerity  the  attacks  of  disease,  or 
arrest  the  shafts  they  aim  at  the  existence  of  our  clients. 


INDEX. 


A. 

PAGE 

Abdominal  supporters  reprobated 97 

Abrasion  of  mucous  surface  of  os,  case 55 

Abrasion  of  mucous  surface  of  os  to  be  avoided  in  cauterizations  55 

Albuminous  leucorrhoea 35 

Annular  pessary  of  gilt  silver 97 

Acid  nitrate  for  small  polypi 77 

Acid  nitrate  in  bleeding  tumor 84 

Adjustment  of  metroscope  41 

Argent,  nitrat.  in  inflamed  cervix 53 

Antiphlogistic  contacts  with  argent,  nitrat 53 

Adherent  fundus  in  retroversion  90 

Adhesion  of  fundus  90 

Angulated  uterus  in  retroversion  91 

Antagonism  of  parts 92 

Anterior  columna  vaginae  in  retroversion  91 

Anatomical  relations  and  place  of  womb 31 

Argument  for  metroscopic  diagnosis 48 

B. 

Bayle's  account  of  Ricamier's  instrument  20 

Bivalve  speculum-uteri 40 

Blood  from  the  genitalia  often  mistaken  for  menstrua 102 

Bleeding  from  polypus 103 

Bleeding  tumor  or  hsematoma  of  womb  73 

Boivin's  plates  not  useful 19 

C. 

Caoutchouc  bottles  of  Hervez 68 

Case  to  show  in  what  instance  diagnosis  is  impossible  72 


110  INDEX. 

PAGE 

Case  of  strictured  vagina  mistaken  for  diseased  os  79 

Case  of  hydrgemia  from  small  bleeding  polypus 78 

Case  of  inflammation  framboistc,  with  plate 43 

Case  of  molluscum  on  cervix  50 

Case  of  bleeding  tumor  in  cervix 83 

Case  of  hygroma  on  cervix > 85 

Carcinomatous  tumor  of  cervix  cured 83 

Component  elements  of  womb 26 

Corpus  mucosum  of  cervix  inflamed 46 

Cauterization  of  cervix  by  Lallemand's  port-caustic 71 

Currant-like  polypi  of  os,  with  plate 76,  77 

Canal  of  cervix  obstructed  by  albumen,  cause  of  sterility  56 

Canal  of  cervix,  hcematoma  in  the 73 

Complement  of  the  forces  in  the  reproductive  organs 24 

Contracted  columna  anterior  renders  retroversion  less  curable 92 

Contro-stimulant  power  of  the  nitrate  of  silver 54 

Cervix  uteri,  hypertrophy  of  the 67 

Columna  anterior  vagina  permanently  contracted 91 

Cervix,  inflamed  case  of,  with  plate 57,  58 

Cervical  distinguished  from  vaginal  leucorrhcea  34 

Comparison  of  touching  with  metroscopy  as  diagnostic  21 

Cephalalgia  from  irritation  of  womb 32 

Cervix  uteri,  bleeding  tumor  removed  from  the 83 

Chronic  tympany  from  irritated  womb 32 

Competency  of  professional  people  in  the  cases  23 


D. 

Diagnostics  of  sexual  diseases  deemed  difficult 18 

Diagnosis,  its  importance  as  means  of  success 37 

Diagnosis,  physical,  being  declined,  the  practice  is  empirical 22 

Diagnosis  by  touching  by  some  persons  supposed  to  be  always  sufficient..  21 

Diagnosis  of  retroversion 66 

Diagnosis  of  polypus  uteri  difficult  in  some  cases  99 

Diagnosis  of  hypertrophy  of  the  womb 101 

Diagnosis  of  stricture  vaginae 79 

Debility  from  leucorrhcea  explained 38 

Differential  means  of  diagnosis  21 

Dimensions  of  the  womb 27 

Dimensions  of  the  gravid  womb 27 

Discrimination  of  vaginal  and  cervical  leucorrhcea  necessary 34,  36 

Disturbing  power  of  sexual  disorders 25 

Drawings  and  colored  prints  unsatisfactory  in  most  cases 19 

Duverney's  glands,  discharge  from,  mistaken  for  fluor  albus 34 


INDEX.  Ill 

E. 

PAGE 

Elementary  or  constituent  tissues  of  the  womb 21 

Empirical  practice  when  physical  diagnosis  is  disallowed  22 

Epithelial  surface  of  os  rarely  abraded 55 

Equable  development  of  womb  or  hypertrophy 28 

Evans's  (Dr.  Charles)  improved  elastic  annular  pessary  96 


Falling  of  the  womb  is  relaxation  of  utero-sacral  ligaments 88 

Fatal  monorrhagia  without  organic  lesion,  case  of 104 

Fastidiousness  as  to  diagnosis 22 

Flexion  of  womb,  with  figure  90 

Fluor  albus  often  depends  on  inflamed  cervix 32,  33 

Follicles  of  cervix,  albuminous  secretion  from  the  35 

Framboisee  inflammation,  irregular  show  from 75 

Frequency  of  retroversion  61 

Fundus  uteri,  adhesion  of 90 


G. 

Generic  and  genetic  forces,  relations  of  the 26 

Gluey  fluor  albus  38 

Guessing  at  the  case  22 

Gutta  percha  ring-pessary  of  Evans  96 


H. 

Hoematoma  in  cervix  uteri 73 

Hemorrhage  from  hsematoma  uteri  fatal 74 

Hemorrhage  from  the  womb,  often  mistaken  for  menstrua 75 

Hemorrhage  from  the  womb,  fatal,  with  no  organic  lesion 104 

Hooper's  plates  referred  to 19 

Hygroma  on  cervix  uteri,  with  a  plate 85 

Hypertrophy  of  the  womb,  diagnosis  of 101 

Hypertrophy  of  the  womb 27 

Hypertrophy  of  the  womb,  physiological  or  pathological 27,  28,  29 

Hydrsemia  from  sexual  disorders 32 

Hysteria,  probably  radiated  from  reproductive  system 25 

Hysterical  state  from  inflamed  cervix,  case  of 50 


112  INDEX. 

I. 

PAGE 

Ideal  of  reproductive  apparatus 26 

Ideal  model  or  standard  specimen  of  uterus 29 

Ideal  of  operations  to  be  performed  with  escharotics 54 

Inadequacy  of  touching  for  diagnosis 22 

Inner  wall  of  womb  degenerated,  not  to  be  diagnosticated  always 72 

Indurating  inflammation  of  cervix,  obstinate  case  of. 57 

Injections  per  vaginam  for  inflamed  cervix,  little  relied  on 37 

Involution  of  womb  as  antithesis  of  evolution 29 

Involutive  force  cures  hypertrophy 29 

J. 

Jus  docendi,  &c 23 

K. 

Knowledge,  not  belief,  demanded  in  diagnosis 49 


L. 

Lallemand's  porM&iustic 77 

Leucorrhcea  from  affections  of  uterus  alone 33 

Ligamenta  utero-sacralia 88 

Ligation  for  tumor  of  cervix,  case,  with  plate  83 


M. 

Medical  men  alone  to  decide  on  necessity  for  metrdscopic  diagnosis....  24 

Medical  men  of  United  States,  competent  and  honest 23 

Medical  profession  injured  by  specialization  of  practice 18 

Menstrua  depend  alone  on  ovulation 75 

Menstrua  not  always  coincident  with  bleeding  from  organs 102 

Menstrua,  irregularity  of  as  to  quantity  from  inflamed  cervix 75 

Menstruation,  profuse,  often  depends  on  currant-like  excrescences  of  os  76 

Menorrhagia,  fatal  case  of 104 

Metroscope  of  Recamier,  his  account  of 20 

Metroscope  objected  to  by  some  as  useless 21 

Metroscope,  various  forms  of 38 

Metroscope,  Recamier's,  preferred  by  author 39 

Molluscum  of  cervix  uteri 50 


INDEX.  113 


PAGE 

Metroscopy,  relative  indelicacy  of  Touching  and 21 

Motives  to  write  this  essay 17 

Muciparous  apparatus  of  cervix 47 


N. 

Nitrate  of  silver,  antiphlogistic  contacts  with 53, 

Nitrate  of  silver,  curative  contacts  with  t 53 

Nitrate  of  silver,  destructive  contacts  with 53 

Nitrate  of  silver,  indifferent  contacts  with 53 

Non-coincidence  of  menstruation  and  genital  hemorrhages 75 

Normal  hypertrophy  of  the  womb 27 


0. 

Orifice  of  stricture  in  vagina  mistaken  for  os  uteri 79 

Os  uteri,  its  normal  appearance 43 

Os  uteri,  excessively  patulous 75 

Os  uteri  near  pubis  in  retroversions 89 

Ovulation  is  the  direct  cause  of  menstruation 75 


Palpitation  of  heart  from  womb  diseases 32 

Pathology  of  retroversion 84 

Pathology  of  hypertrophy 27,  28,  29 

Pathology  of  raspberry-coloured  inflammation 42,  55 

Pessary,  Evans's  annular 93 

Pessary,  silver  gilt,  of  author 97 

Pessary,  glass,  objections  to 93 

Pessary,  globe,  fails  to  cure  retroversion 92 

Pessary,  watch-spring,  of  author  94 

Pessary,  whalebone  ring 93 

Pathological  hypertrophy 27,  29 

Physiological  hypertrophy  of  womb  27 

Physical  diagnosis  of  sexual  disorders  indispensable  38 

Place  of  the  womb  in  the  pelvis,  and  its  anatomical  relations 31 

Plate  of  the  womb 29 

Polypus  with  hemorrhage 103 

Polypus  of  thirty-two  pounds  weight 98 


114  INDEX. 

PAGE 

Polypus  of  the  os  causes  drainage  of  blood,  with  anaemia 78 

Practice  in  sexual  maladies  not  a  specialty 18 

Prolapsus  uteri 88 

Pure  silver  to  make  annular  pessary  with 97 


R. 

Rareness  of  ulcer  of  os  uteri  or  cervix 24 

Raspberry-colored  cervix 42 

Raspberry  tinted  inflammation  of  os,  with  plate 43 

Recamier's  (Professor)  metroscope  19 

Recamier's  (Professor)  Recherches  sur  le  Cancer  quoted 19 

Recamier's  (Professor)  speculum  uteri  described,  with  plate 40 

Reaction  of  reproductive  organs  on  the  animal  economy 24 

Reproductive  force  not  an  indifferent  in  woman's  health 25 

Reproductive  force,  when  morbid,  becomes  a  radiant  of  disturbance  ...  28 

Retroflexion  of  womb 62 

Retroversion  certainly  curable  by  means  of  the  annulus 96 

Retroversion,  old  cases  of,  with  condensed  anterior  columna 91 

Retroversion,  see-saw  descent  of  womb  in  89 

Retroversion  not  easily  treated  with  the  globe 92 

Retroversion,  gilt  annulus  of  author  in  97 

Retroversion  with  hypertrophy  63 

Retroversion,  its  frequency 61 

Resolvent  or  deobstruent  power  of  arg.  nitrat 53 


S. 

Sanguine  discharges  of  vagina  mistaken  for  menstrua  102 

Sexual  diseases  act  on  the  constitution  as  hysteria 25 

See-saw  descent  of  womb  89 

Shortening  of  anterior  columna  in  retroversion,  its  effects  91 

Silver,  nitrate  of,  in  diseases  of  cervix  and  os 43 

Silver,  nitrate  of,  ideal  of  purpose  in  using  the 54 

Simpson's  sound,  a  case  in  which  it  passed  6j  inches  in  utero 66 

Speculum  uteri,  objections  to,  motives  for 19-21 

Speculum  uteri,  Recamier's 19 

Speculum  uteri,  bivalve  40 

Speculum  uteri  preferred  by  author,  with  plate 39 

Spasm  from  sexual  diseases  32 

Specialty,  objections  to  107 


INDEX.  115 

PAGE 

Specialty  injurious  to  medical  profession  18 

Standard  or  ideal  uterus  26 

Sterility  by  albuminous  leucorrhoea  56 

Stricture  of  vagina  79 

Stricture  of  cervix 80 

Swellings  and  tumors,  difference  between  them 88 


T. 

Tissues  of  the  womb 26 

Torpor  of  bowels  from  uterine  irritations 32 

Tympany  from  diseased  os  86 

Touching  averred  to  supersede  the  metroscopic  diagnosis 21 

Touching  for  diagnosis 38 


U. 

Ulcer  of  womb  a  rare  disorder 55 

Unequable  development  of  womb  constitutes  a  tumor 28 

Uterine  disorders  as  easily  diagnosticated  as  other  diseases 18 

Uterine  disorders  should  be  treated  by  the  family  physician 18 

Uterine  polypus,  remarks  on,  as  in  plate 98 

Utero-sacral  ligaments  or  folds  of  peritoneum 88 

Utero-abdominal  supporters,  reprobation  of  97 

Uterus  with  hygroma  and  tumor  on  fundus,  plate 86 


Vagina  restrained  from  falling  by  ligamenta  utero  sacralia 88 

Vaginal  stricture  mistook  for  os  uteri,  figure 79 

Vaginal  leucorrhoea  not  albuminous  35 

Vaginal  leucorrhoea  less  important  than  uterine  33 

Vaginal  injections  little  to  be  relied  on  in  inflamed  cervix 37 

Vagueness  of  opinion  on  sexual  disorders 17 


W. 

"VVatchspring  annular  pessary  of  author 94 

Watery  or  cream-like  fluor  albus  34 

Weight  of  womb,  non-gravid  and  gravid  27 


116  INDEX, 


PAGE 

Womb,  ideal  model  or  standard  of,  plate 29 

Womb,  normal,  hypertrophy  of 25,  101 

Womb,  pathological  hypertrophy  of  the 27,  29 

Womb,  involutive  power  of  the „• 28 

Womb,  flexion  of,  with  figure 90 

Womb,  falling  or  prolapsus  of , 88 

Womb,  how  situated  in  pelvis  31 

Womb,  retroverted,  with  plate  , 61 

Womb-sound,  Simpson's 101 


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pursued  in  our  colleges,  and  containing  ample  practical  directions  and  instructions,  in  addition  to 
the  anatomical  details  presented,  it  possesses  claims  to  the  immediate  attention  of  teachers  and 
students.     It  will  appear  in  time  for  the  Fall  session  of  the  present  year. 


ANALYTICAL    COMPENDIUM 


OF  MEDICAL  SCIENCE,  containing  Anatomy,  Physiology,  Surgery,  Midwifery, 
Chemistry,  Materia  Medica,  Therapeutics,  and  Practice  of  Medicine.  By  John  Neill,  M.  D., 
ondF.  G  Smith,  M.  D.  Second  and  enlarged  edition,  one  thick  volume  royal  12mo.  of  over 
1000  pages,  with  350  illustrations.     |2P  See  Neill. 


ABEL   (F.    A.),    F.  C.  S. 
Professor  of  Chemistry  in  the  Royal  Military  Academy,  Woolwich. 

AND 

C.    L.    BLOXAM, 

Formerly  First  Assistant  at  the  Royal  College  of  Chemistry. 

HANDBOOK  OF  CHEMISTRY,  Theoretical,  Practical,  and  Technical,  with  a 

Recommendatory  Preface  by  Dr.  Hofmann.     In  one  large  octavo  volume  of  062  pages,  with 

illustrations.     {Just  Issued.) 

It  must  be  underwood  that  this  is  a  work  fitted  for  \  cessary,  with  such  manipulatory  details  as  rendered 
the  earnest  student,  who  resolves  to  pursue  for  him-  j  Faraday's  '  Chemical  Manipulations'  so  valuable  at 
self  a  steady  search  into  the  chemical  mysteries  of  the  time  of  its  publication.  Beyond  this,  the  im- 
creation.  For  such  a  student  the  '  Handbook'  will  portance  of  the  work  is  increased  by  the  introduc- 
prove  an  excellent  guide,  since  he  will  find  in  it,  tion  of  much  of  the  technical  chemistry  of  the  manu- 
not  merely  the  approved  modes  of  analytical  investi-  I  factory." — Dr.  Hofmann' s  Preface. 
g-ation,  but  most  descriptions  of  the  apparatus  ne-  j 


ASHWELL    (SAMUEL),    M.  D., 

Obstetric  Physician  and  Lecturer  to  Guv's  Hospital,  London 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO  WOMEN. 

Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.  Third  American,  from  the  Third 
and  revised  London  edition.     In  one  octavo  volume,  of  528  pages.    {Now  Ready.) 
The  most  useful  practical  work  on  the  subject  in 

the   English   language.  —  Boston  Med.   and  Surg. 

Journal. 


The  most  able,  and  certainly  the  most  standard 
and  practical,  work  on  female  diseases  that  we  have 
yet  seen. — Medico-Chirurgical  Review. 

We  commend  it  to  our  readers  as  the  best,  practi- 
tieul  treatise  on  the  subject  which  has  yet  appeared 
— London  Lancet. 

The  young  practitioner  will  find  it  invaluable, 
while  those  who  have  had  most  experience  will  yet 
find  something  to  learn,  and  much  to  commend,  in  a 


book  which  shows  so  much  patient  observation, 
practical  skill,  and  sound  sense. — British  and  Fo- 
reign Med.  Review. 


With  no  work  are  we  acquainted,  in  which  the 
pleasant  and  the  useful  are  more  happily  blended.  1 
combines  the  greatest  elegance  of  style  with  the 
most  sound  and  valuable  practical  information. 
We  feel  justitied  in  recommending  it.  in  unqualified 
terms,  to  our  readers,  as  a  book  from  which  they 
can  scarcely  fail  to  derive  both  pleasure  and  im- 
provement. It  is  truly  a  model  for  medical  compo- 
sitions.— Southern  Med.  and  Surg.  Journal. 


ARNOTT   (NEILL),  M.  D. 
ELEMENTS    OF    PHYSICS;    or  Natural  Philosophy,  General  %nd  Medical. 

Written  for  universal  use,  in  plain  or  non-technical  language.    A  new  edition,  by  Isaac  Days, 
M.  D.     Complete  in  one  octavo  volume,  of  484  pages,  with  about  two  hundred  illustrations. 


TACTICAL   TREATISE    ON   INFLAMMATION  OF  THE  UTERUS, 

CERVIX  AND   APPENDAGES,  and  on  its  connection  with  Uterine  Disease.     Fourth 


BENNETT    (HENRY),  M.  D. 
A   PRj 

ITS  CER 

American,  from  the  third  and  revised  London  edition.     In  one  neat  octavo  volume,  of  430  pages, 

with  wood-cuts.      Just  Issued.) 

This  edition  will  be  found  materially  improved  over  its  predecessors,  the  author  having  carefully 
revised  it,  and  made  considerable  additions,  amounting  to  about  seventy-live  pages.  . 

This  edition  has  been  carefully  revised  and  altered,  When,  a  few  years  back,  the  first  edition  of  the 
and  various  additions  have  been  made,  which  render  present  work  was  published,  the  subject  was  one  al- 
ii more  complete,  and,  if  possible,  more  worthy  of  most  entirely  unknown  to  the  obstetrical  celebrities 
the  high  appreciation  in  which  it  is  held  by  the  \  of  the  day  ;  and  even  now  we  have  reason  to  know 
medical  profession  throughout  the  world.  A  copy  j  that  the  bulk  of  the  profession  are  not  fully  itlive  to 
should  be  in  the  possession  of  every  physician. —  :  the  importance  and  frequency  of  the  disease  of  which 
Charleston  Med.  Journal  and  Review.  \  it  takes  cognizance.     The  present  edition  is  so  much 

We  are  firmly  of  opinion  that  in  proportion  as  a    enlarged,  altered,  and  improved,  that  it  can  scarcely 
kuowledge  of  uterine  diseases  becomes  more  appre-    he  considered  the  same  work.-Dr.  Ranking* s  46- 
siuted,  this  work  will  be  proportionality  established    strilct- 
as  a  text-book  in  the  profession. — The  Lancet.  , 


BLANCHARD   <fc    LEA'S   MEDICAL 


BROWN    (ISAAC    BAKER), 

Surgeon- Accoucheur  to  St.  Mary's  Hospital,  &c. 

ON  SOME  DISEASES  OF  WOMEN  ADMITTING  OF  SURGICAL  TREAT- 

MENT.     Wilh  handsome  illustrations.     One  vol.  8vo.     (At  Press.) 

Publishing  in  the  "Medical  News  and  Library"  for  1855  and  185G.     See  preceding  page. 

Mr.  Brown  has  earned  for  himself  a  high  reputa-  [  and  merit  the  careful  attention   of  every   surgeon- 
tion  in  the  operative  treatment  of  sundry  diseases  ]  accoucheur. — Association  Journal. 
and  injuries  to  which  females  are  peculiarly  subject,  j      ,,T    .  ,      .       .  ,.       ...    ,      . 

We  can  truly  say  of  his  work  that  it  is  an  important  '  *  e  have  no  hesitation  in  recommending  tins  book 
addition  to  obstetrical  literature.  The  operative  I  ^  the  carelul  attention  of  a  1  surgeons  who  make 
suggestions  and  contrivances  which  Mr.  Brown  dp-  I  female  complaints  a  part  of  heir  study  and  practice, 
scnbes,  exhibit  much  practical  sagacity  and   skill,    -Dvblm  Quarterly  Journal. 


BENNETT    (J.    HUGHES),    M.D.,    F.  R.  S.  E., 

Professor  of  Clinical  Medicine  in  the  University  of  Edinburgh,  &c. 

THE  PATHOLOGY  AND  TREATMENT  OF  PULMONARY  TUBERCU- 

LOSIS,  and  on  the  Local  Medication  of  Pharyngeal  and  Laryngeal  Diseases  frequently  mistaken 
for  or  associated  with,  Phthisis.  In  one  handsome  octavo  volume,  with  beautiful  wood-cuts, 
pp.  130.     (Lately  Issued.) 

BILLING    (ARCHIBALD),  M.  D. 
THE  PRINCIPLES  OF  MEDICINE.     Second  American,  from  the  Fifth  and 

Improved  London  edition.     In  one  handsome  octavo  volume,  extra  cloth,  250  pages. 


BLAKISTON    (PEYTON),  M.  D.,  F.  R.  S.,  &.c. 
PRACTICAL    OBSERVATIONS    ON    CERTAIN    DISEASES    OF    THE 

CHEST,  and  on  the  Principles  of  Auscultation.     In  one  volume,  8vo.,  pp.  384. 


BURROWS    (GEORGE),  M.D. 
ON  DISORDERS  OF  THE  CEREBRAL  CIRCULATION,  and  on  the  Con- 

nection  between  the  Affections  of  the  Brain  and  Diseases  of  the  Heart.     In  one  8vo.  vol.,  with 
colored  plates,  pp.  216. 

BUDD  (GEORGE),  M.  D.,  F.  R.  S., 

Professor  of  Medicine  in  King's  College,  London. 

ON   DISEASES   OF   THE   LIVER.     Second  American,  from  the  second  and 

enlarged  London  edition.     In  one  very  handsome  octavo  volume,  with  four  beautifully  colored 
plates,  and  numerous  wood-cuts,     pp.468.     New  edition.     (Lately  Issued.) 

The  full  digest  we  have  given  of  the  new  matter  work  must  be  the  authority  of  the  srreat  mass  of 
Introduced  into  the  present  volume,  is  evidence  of  British  practitioners  on  the  hepatic  diseases  ;  and  it 
the  value  we  place  on  it.  The  fact  that  the  profes-  is  satisfactory  that  the  subject  has  been  taken  up  by 
sion  has  required  a  second  edition  of  a  monograph  so  able  and  experienced  a  physician. — British  and 
such  as  that  before  us,  bears  honorable  testimony  Foreign  Medico-Chirurgical  Review. 
to  its   usefulness.      For   many   years,  Dr.   Budd's 

BY  THE  SAME  AUTHOR.      (Just  Ready.) 

ON  THE   ORGANIC   DISEASES   AND  FUNCTIONAL  DISORDERS  OF 

THE  STOMACH.     In  one  neat  octavo  volume. 

While  special  treatises  have  been  multiplying  upon  almost  all  the  different  classes  of  diseases,  there 
has  lony  been  felt  the  want  of  an  authoritative  work  on  the  disorders  of  the  stomach,  which  con- 
stitute, perhaps,  a  larger  proportion  of  the  daily  practice  of  the  physician  than  any  other  class  of 
maladies.  To  supply  this  want  has  been  the  object  of  the  author,  and  his  reputation  is  an  ample 
guarantee  o(  the  value  of  his  labors. 

From  the  high  position  occupied  by  Dr.  Budd  as  '  precepts,  both  of  diagnosis  and   treatment,  denote 
a  teacher,  a  writer,  and  a  practitioner,  it  is  almost     the  character  of  a  thoughtful  and  experienced  phy- 
needless  to  state  that  the  present  book  may  be  con-  j  sician. — London  Med.  Times  and  Gazette,  December, 
suited  with  great  advantage.   It  is  written  in  an  easy  j  1855. 
style,  the  subjects  are  welt  arranged,  and  the  practiul  | 


BUSHNAN  (J.   S.),    M.  D. 
THE   PHYSIOLOGY  OF   ANIMAL  AND  VEGETABLE   LIFE;  a  Popular 

Treatise  on  the  Functions  and  Phenomena  of  Organic  Life.   In  one  handsome  royal  12mo.  volume, 
with  over  one  hundred  illustrations,     pp.  234. 

BIRD  (GOLDING),  A.  M.,  M .  D.,  &c. 
URINARY     DEPOSITS  :     THEIR     DIAGNOSIS,    PATHOLOGY,    AND 

THERAPEUTICAL  INDICATIONS.     A  new  and  enlarged  American,  from  the  last  improved 
London  edition.    With  over  sixty  illustrations.     In  one  royal  12ino.  volume,  extra  cloth,  pp.  372. 

It  can  scarcely  be  necessary  for  us  to  say  anything  .  extension  and  satisfactory  employment  of  our  thera- 
of  the  merits  of  this  well-known  Treatise,  which  so  1  peutic  resources.  In  the  preparation  of  this  new 
admirably  briugs  into  practical  application  the  re- 
sults of  those  microscopical  and  chemical  researches 
regarding  the  physiology  and  pathology  of  the  uri- 
nary secretion,  which  have  contributed  so  much  to 
the  increase  of  our  diagnostic  powers,  aud  to  the  <  Medico-C hirurgical  Review 


j. ...w    .~v...„. — u.      ...    ...^   ,,.  w1.u.  uv.....  ...    „...u   u^ ., 

edition  of  his  work,  it  is  obvious  that  Dr.  Golding 
Bird  has  sparedno  pains  to  render  ita  faithful  reprt*- 
sentation  of  the  present  state  of  scientific  knowledge 
on  the  subject  it  emh  races.  —  The  British  and  Foreign 


BY   THE   SAME   AUTHOR, 
r-n-v-rmo     r\T7\     XT  I  TTTD  A  T       DEJTT  ,TkCrkT>TJA7"  . 


AND    SCIENTIFIC    PUBLICATIONS. 


BARTLETT  (ELISHA),  M .  D. 
THE   HISTORY,  DIAGNOSIS,  AND  TREATMENT  OF  THE   FEVERS 

OF  THE  UNITED  STATES.     Third  edition,  revised  and  improved.     In  one  octavo  volume, 

of  six  hundred  pages,  beautifully  printed,  and  strongly  bound. 

The  masterly  and  elegant  treatise,  by  Dr.  Bartlett 
is  invaluable  to  the  American  student  and  practi- 
tioner.— Dr.  Hohnes's  Report  to  the  Nat.  Med.  Asso- 
ciation. 


We  regard  it,  from  the  examination  we  have  made 
of  it,  the  best  work  on  fevers  extant  in  our  language, 
and  as  such  cordially  recommend  it  to  the  medical 
public. — St.  Louis  Medical  and  Surgical  Journal. 

Take  it  altogether,  it  is  the  most  complete  history 
of  our  fevers  which  has  yet  been  published,  and 
every  practitioner  should  avail  himself  of  its  con- 
tents.— The  Western  Lancet. 


Of  the  value  and  importance  of  such  a  work,  it  is 
needless  here  to  speak  ;  the  profession  of  the  United 
States  owe  much  to  the  author  for  the  very  able 
volume  which  he  has  presented  to  them,  and  for  the 
careful  and  judicious  manner  in  which  he  has  exe- 
cuted his  task.  No  one  volume  with  which  we  are 
acquainted  contains  so  complete  a  history  of  our 
fevers  as  this.  To  Dr.  Bartlett  we  owe  our  best 
thanks  for  the  very  able  volume  he  has  given  us,  as 
embodying  certainly  the  most  complete,  methodical, 
and  satisfactory  account  of  our  fevers  anywhere  to 
be  met  with. —  The  Charleston  Med.  Journal  and 
Review. 


BUCKLER  (T.   H.),  M.  D., 

Formerly  Physician  to  the  Baltimore  Almshouse  Infirmary,  &c. 

ON  THE  ETIOLOGY,  PATHOLOGY,  AND  TREATMENT  OF   FIBRO- 

BRONCHITIS  AND  RHEUMATIC  PNEUMONIA.    In  one8vo.  volume, extra  cloth,  pp.  150. 

BOWMAN  (JOHN    E.),  M.D. 
PRACTICAL   HANDBOOK    OF    MEDICAL    CHEMISTRY.     Second  Ame- 

rican,  from  the  third  and  revised  Engli>h  Edition.     In  one  neat  volume,  royal  12mo.,  with  nu- 
merous illustrations,     pp.  288.    (Now  Ready.) 

BY  THE  SAME  AUTHOR. 

INTRODUCTION    TO    PRACTICAL    CHEMISTRY,    INCLUDING    ANA- 

LYSIS.     With  numerous  illustrations.     In  one  neat  volume,  royal  12mo.     pp.  350. 


BARLOW   (GEORGE  H.),    M.D. 
A  MANUAL  OF  THE    PRACTICE   OF  MEDICINE.     With  Notes  and  Ad- 

ditions  by  the  American  Editor.     In  one  octavo  volume.     (Now  Ready.) 

The  position  of  the  author  as  physician  to  Guy's  Hospital  and  other  large  public  institutions,  is 
a  sufficient  guarantee  of  the  extent  and  value  of  the  experience  which  is  here  systematically  re- 
corded and  condensed.  His  aim  throughout  has  been  to  produce  a  practical  work,  on  which  the 
student  can  rely  as  a  guide,  and  to  which  the  practitioner  can  refer  with  confidence.  The  additions 
by  the  editor  comprise  chapters  on  Cerebro-spinal  Meningitis,  Cholera  Infantum,  and  Yellow  Fever, 
besides  numerous  notes  wherever  the  diseases  or  practice  of  this  country  seemed  to  render  them 
necessary  or  desirable. 

BEALE  (LIONEL    JOHN),  M.  R.  C.  S.,  &c. 
THE    LAWS   OF    HEALTH    IN   RELATION   TO    MIND    AND   BODY. 

A  Series  of  Letters  from  an  old  Practitioner  to  a  Patient.     In  one  volume,  royal  12mo.     pp.296. 


BLOOD  AND  URINE  (MANUALS  ON). 
BY  JOHN  WILLIAM  GRIFFITH,   G.  OWEN  REESE,  AND  ALFRED 

MARKWICK.     One  thick  volume,  royal  12mo.,  extra  cloth,  with  plates,    pp.  460. 


BRODIE  (SIR  BENJAMIN   C),  M.  D.,  &.c. 
CLINICAL  LECTURES  ON  SURGERY.     1  vol.  8vo.,  cloth.     350  pp. 


COLOMBAT  DE  L'ISERE. 
A  TREATISE   ON   THE    DISEASES    OF   FEMALES,  and  on  the  Special 

Hygiene  of  their  Sex.  Translated,  with  many  Notes  and  Additions,  by  C.  D.  Meigs,  M.  D. 
Second  edition,  revised  and  improved.  In  one  large  volume,  octavo,  with  numerous  wood-cuts, 
pp.  720. 


The  treatise  of  M.  Colombat  is  a  learned  and  la- 
borious commentary  on  these  diseases,  indicating 
very  considerable  research,  great  accuracy  of  judg- 
ment, and  no  inconsiderable  personal  experience. 
With  the  copious  notes  and  additions  of  its  experi- 


enced and  very  erudite  translator  and  editor,  Dr. 
Meigs,  it  presents,  probably,  one  of  the  most  com- 
plete and  comprehensive  works  on  the  subject  we 
possess. — American  Med.  Journal. 


CURLING    (T.     B.),    F.  R.S., 
Surgeon  to  the  London  Hospital,  &c. 

A  PRACTICAL  TREATISE  ON  DISEASES  OF  THE  TESTIS,  SPERMA- 
TIC CORD,  AND  SCROTUM.  Second  American,  from  the  second  and  enlarged  English  edi- 
tion.    In  one  handsome  octavo  volume,  with  numerous  illustrations.     (At  Press.) 


COPLAND  (JAMES),  M.  D.,  F.  R.  S.,  &c. 
OF   THE  CAUSES,  NATURE,  AND  TREATMENT   OF    PALSY    AND 

APOPLEXY.    In  one  volume,  royal  12mo.,  extra  cloth,    pp.  326. 


f> 


BLANCHARD  &  LEA'S   MEDICAL 


CARPENTER  (WILLIAM    B.),   M.  D.,  F.  R.  S.,  &.C., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  applications  to 

Psychology,  Pathology,  Therapeutics,  Hygiene,  and  Forensic  Medicine.  A  new  American,  from 
the  last  anil  revised  London  edition.  With  nearly  three  hundred  illustrations.  Edited,  with  addi- 
tions, by  Francis  Gurney  Smith,  M.  D.,  Professor  of  the  Institutes  of  Medicine  in  the  Pennsyl- 
vania Medical  College,  &c.  In  one  very  large  and  beautiful  octavo  volume,  of  about  nine  hundred 
large  pages,  handsomely  printed  and  strongly  bound  in  leather,  with  raised  bands.     (Now  Ready.) 

The  best  text-book  in  the  language  on  this  ex- 
tensive subject. — London  Med.  Times. 

A  complete  cyclopaedia  of  this  branch  of  science. 
— N.  Y.  Med.  times. 


The  most  complete  work  on  the  science  in  our 
language.— Am.  Med.  Journal. 

The  most  complete  exposition  of  physiology  which 
any  language  can  at  present  give.— Brit,  and  For. 
Med.-Chirurg.  Review. 

We  have  thus  adverted  to  some  of  the  leading 
-'additions  and  alterations,"  which  have  been  in- 
troduced by  the  author  into  this  edition  of  his  phy- 
siology. These  will  be  found,  however,  very  far  to 
exceed  the  ordinary  limits  of  a  new  edition,  "the 
old  materials  having  been  incorporated  with  the 
new,  rather  than  the  new  witli  the  old."  It  now 
certainly  presents  the  most  complete  treatise  on  the 
subject  within  the  reach  of  the  American  reader; 
nnd  while,  for  availability  as  a  text-book,  we  may 
perhaps  regret  its  growth  in  bulk,  we  are  sure  that 
the  student  of  physiology  will  feel  the  impossibility 
of  presenting  a  thorough  digest  of  the  facts  of  the 
science  within  a  more  limited  compass. — Medical 
Examiner. 

The  greatest,  the  most  reliable,  and  the  best  book 
on  the  subject  which  we  know  of  in  the  English 
language. — Stethoscope. 


The  standard  of  authority  on  physiological  sub- 
jects. *  *  *  In  the  present  edition,  to  particularize 
the  alterations  and  additions  which  have  been  made, 
would  require  a  review  of  the  whole  work,  since 
scarcely  a  subject  has  not  been  revised  and  altered, 
added  to,  or  entirely  remodelled  to  adapt  it  to  the 
present  state  of  the  science. — Charleston  Med.  Journ. 

Any  reader  who  desires  a  treatise  on  physiology 
may  feel  himself  entirely  safe  in  ordering  this. — 
Western  Med.  and  Surg.  Journal. 

From  this  hasty  and  imperfect  nllusion  it  will  be 
seen  by  our  readers  that  the  alterations  and  addi- 
tions to  this  edition  render  it  almost  a  new  work — 
and  we  can  assure  our  readers  that  it  is  one  of  the 
best  summaries  of  the  existing  facts  of  physiological 
science  within  the  reach  of  the  English  student  and 
physician. — JV.  Y.  Journal  of  Medicine . 

The  profession  of  this  country,  and  perhaps  also 
of  Europe,  have  anxiously  and  for  some  lime  awaited 
the  announcement  of  tiiis  newedition  of  Carpenter's 


The  most  complete  work  now  extant  in  our  Ian-  ,  Human  Physiology.     His  former  editions  have  for 
euage  — N.  O.  Med.  Register.  m;'n>'  years  been  almost  the  only  text-book  on  Phy- 

*     b  I  siology  in  all  our  medical  schools,  and   its  cneula- 

The  changes  are  too  numerous  to  admit  of  an  ex-  j  tion  among  the  profession  has  been  unsurpassed  by 
tended  notice  in  this  place.  At  every  point  where  :  any  work  in  any  department  of  medical  science, 
the  recent  diligent  labors  of  organic  chemists  and  I  it  is  quite  unnecessary  for  us  to  speak  of  this 
micrographers  have  furnished  interesting  and  v.ilu-  !  work  as  its  merits  would  justify.  The  mere  an 
able  facts,  they  have  been  appropriated,  and  no  pains  |  nouncement  of  its  appearance  will  afford  the  highest 
have  been  spared,  in  so  incorporating  and  arranging  ;  pleasure  to  every  student  of  Physiology,  while  its 
them  that  the  work  may  constitute  one  harmonious  I  perusal  will  be  of  infinite  service  in  advancing 
system. — Southern  Med.  and  Surg.  Journal.  physiological  science. — Ohio  Med.  and  Surg.  Journ. 


RY    THE   SAME    AUTHOR.      (Now  Ready.) 

PRINCIPLES  OF  COMPARATIVE   PHYSIOLOGY.     New  American,  from 

the  Fourth  and  Revised  London  edition.     In  one  large  and  handsome  octavo  volume,  with  over 

three  hundred  beautiful  illustrations,     pp.  752. 

The  delay  which  has  existed  in  the  appearance  of  this  work  has  been  caused  by  the  very  ihorotigh 
revision  and  remodelling  which  it  has  undergone  at  the  hands  of  the  author,  and  the  large  number 
of  new  illustrations  which  have  been  prepared  for  it.  It  will,  therefore,  be  found  almost  a  new 
wcrk,  nnd  fully  up  to  the  day  in  every  department  of  the  subject,  rendering  it  a  reliable  text-book 
for  all  students  engaged  in  this  branch  of  science.  Every  effort  has  been  made  to  render  its  typo- 
graphical linish  and  mechanical  execution  worthy  of  its  exalted  reputation,  and  creditable  to  the 
mechanical  arts  of  this  country. 


This  book  should  not  only  be  read  but  thoroughly 
sludied  by  every  member  of  the  profession.  None 
are  too  wise  or  old,  to  be  benefited  thereby.  But 
especially  to  the  younger  class  would  we  cordially 
commend  it  as  best  fitted  of  any  work  in  the  English 
language  to  qualify  them  for  the  reception  and  coin- 
prehension  of  those  truths  which  are  daily  being  de- 
veloped in  physiology. — Medical  Counsellor. 

Without  pretending  to  it,  it  is  an  Encyclopedia  of 
the  subject,  accurate  and  complete  in  all  respects — 
a  truthful  reflection  of  the  advanced  state  at  which 
the  science  has  now  arrived. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  truly  magnificent  work — in  itself  a  perfect  phy- 
siological study. — Ranking's  Abstract. 

This  work  stands  without  its  fellow.  It  ia  one 
few  men  in  Europe  could  have  undertaken ;  it  is  one 


no  man,  we  believe,  could  have  brought  to  so  suc- 
cessful an  issue  as  Dr.  Carpenter.  It  required  for 
its  production  a  physiologist  at  once  deeply  read  in 
the  labors  of  others  capable  of  taking  a  general, 
critical,  and  unprejudiced  view  of  those  labors  and 
of  combining  the  varied,  heterogeneous  materials  at 
his  disposal,  so  as  to  form  an  harmonious  whole. 
We  feel  that  this  abstract  can  give  the  reader  a  very 
imperfect  idea  of  the  fulness  of  this  work,  and  no 
idea  of  its  unity,  of  the  admirable  manner  in  which 
material  has  been  brought,  from  the  most  various 
sources,  to  conduce  to  its  completeness,  of  the  lucid- 
ity of  the  reasoning  it  contains,  or  of  the  clearness 
of  language  in  which  the  whole  is  clothed.  Not  the 
profession  only,  but  the  scientific  world  at  large, 
must  feel  deeply  indebted  to  Dr.  Carpenler  for  this 
great  work.  It  must,  indeed,  add  hugely  even  to 
his  high  reputation. — Medical  Times. 


BY  the  same  author.     (Preparing.) 

PRINCIPLES  OF   GENERAL   PHYSIOLOGY,    INCLUDING    ORGANIC 

CHEMISTRY  AND   HISTOLOGY.     With  a  General  Sketch  of  the  Vegetable  and  Animal 
Kingdom.     In  one  large  and  very  handsome  octavo  volume,  with  several  hundred  illustrations. 
The  subject  of  general  physiology  having  been  omilted  in  the  last  edition  of  (he  author's  "  Com- 
parative Physiology,"  he  has  undertaken  to  prepare  a  volume  which  shall  present  it  more  tho- 
roughly and  fully  than  has  yet  been  attempted,  and  which  may  be  regarded  as  an  introduction  to 
his  other  works. 


AND    SCIENTIFIC    PUBLICATIONS. 


CARPENTER  (WILLIAM  B.),   M.  D.,  F.  R.  S., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

ELEMENTS  (OR  MANUAL)  OF  PHYSIOLOGY,  INCLUDING  PHYSIO- 
LOGICAL ANATOMY.  Second  American,  from  a  new  and  revised  London  edition.  Withi 
one  hundred  and  ninety  illustrations.     In  one  very  handsome  octavo  volume,    pp.  506. 

In  publishing  the  first  edition  of  this  work,  its  title  was  altered  from  that  of  the  London  volume, 
by  the  substitution  of  the  word  "  Elements"  for  that  of  "  Manual,"  and  with  the  author's  sanction 
the  title  of  "  Elements"  is  still  retained  as  being  more  expressive  of  the  scope  of  the  treatise. 


To  say  that  it  is  the  best  manual  of  Physiology 
now  before  the  public,  would  not  do  sufficient  justice 
to  the  author. — Buffalo  Medical  Journal. 

In  his  former  works  it  would  seem  that  he  had 
exhausted  the  subject  of  Physiology.  In  the  present, 
he  gives  the  essence,  as  it  were,  of  the  whole. — N.  Y. 
Journal  of  Medicine. 

Those  who  have  occasion  for  an  elementary  trea- 
tise on  Physiology,  cannot  do  better  than  to  possess 
themselves  of  the  manual  of  Dr.  Carpenter. — Medical 
Examiner . 


The  best  and  most  complete  exposd  of  modern 
Physiology,  in  one  volume,  extant  in  the  English 
language.— Si.  Louis  Medical  Journal. 

With  such  an  aid  in  his  hand,  there  is  no  excuse 
for  the  ignorance  often  displayed  respecting  the  sub- 
jects of  which  it  treats.  From  its  unpretending  di- 
mensions, it  may  not  be  so  esteemed  by  those  anxious 
to  make  a  parade  of  their  erudition;  but  whoever 
masters  its  contents  will  have  reason  to  be  proud  of 
his  physiological  acquirements.  The  illustrations 
are  well  selected  and  finely  executed.— Dublin  Med. 
Press. 


BY  the  same  author.     (Nearly  Ready.) 

THE  MICROSCOPE  AND  ITS  REVELATIONS.     In  one  handsome  volume, 

with  several  hundred  beautiful  illustrations. 

Various  literary  engagements  have  delayed  the  author's  progress  with  this  long  expected  work. 
It  is  now,  however,  in  an  advanced  state  of  preparation,  and  may  be  expected  in  a  few  month?. 
The  importance  which  the  microscope  has  assumed  within  the  last  few  years,  both  as  a  guide  to 
the  practising  physician  who  wishes  to  avail  himself  of  the  progress  of  his  science,  and  as  an  indis- 
pensable assistant  to  the  physiological  and  pathological  observer,  has  caused  the  want  to  be  severely 
felt  of  a  volume  which  should  serve  as  a  guide  to  the  learner  and  a  book  of  reference  to  the  more 
advanced  student.  This  want  Dr.  Carpenter  has  endeavored  to  supply  in  the  present  volume.  His 
great  practical  familiarity  with  the  instrument  and  all  its  uses,  and  his  acknowledged  ability  as  a 
teacher,  are  a  sufficient  guarantee  that  the  work  will  prove  in  every  way  admirably  adapted  to  its 
purpose,  and  superior  to  any  as  yet  presented  to  the  scientific  world. 

BY   THE   SAME   AUTHOR. 

A  PRIZE  ESSAY  ON  THE  USE  OF  ALCOHOLIC  LIQUORS  IN  HEALTH 

AND  DISEASE.     New  edition,  with  a  Preface  by  D.  F.  Condie,  M.  D.,  and  explanations  of 
scientific  words.     In  one  neat  12mo.  volume,    pp.  178.     {Just  Issued.) 


CHELIUS   (J.  M.),    M.  D., 

Professor  of  Surgery  in  the  University  of  Heidelberg,  &.C. 

A  SYSTEM  OF  SURGERY.     Translated  from  the  German,  and  accompanied 

with  additional  Notes  and  References,  by  John  F.  South.     Complete  in  three  very  large  octavo 
volumes,  of  nearly  2200  pages,  strongly  bound,  with  raised  bands  and  double  titles. 
We  do  not  hesitate  to  pronounce  it  the  best  and 
most  comprehensive  system  of  modern  surgery  with 
which  we  are  acquainted. — Medico-Chirurgical  Re- 
view. 


The  fullest  and  ablest  digest  extant  of  all  that  re- 


lates to  the  present  advanced  state  of  surgical  pa- 
thology.— American  Medical  Journal. 


The  most  learned  and  complete  systematic  treatise 
now  extant.—  Edinburgh  Medical  Journal. 


CLYMER  (MEREDITH),  M.  D.,  &.c. 
FEVERS;     THEIR    DIAGNOSIS,    PATHOLOGY,    AND    TREATMENT. 

Prepared  and  Edited,  with  large  Additions,  from  the  Essays  on  Fever  in  Tweedie's  Library  ot 
Practical  Medicine.     In  one  octavo  volume,  of  600  pages. 


CHRISTISON  (ROBERT),  M.  D.,  V.  P.  R.  S.  E.,  &.c. 
A  DISPENSATORY;  or,  Commentary  on  the  Pharmacopoeias  of  Great  Britain 

the  United  States;  comprising  the  Natural  History,  Description,  Chemistry,  Pharmacy,  Ac- 
is,  Uses,  and  Doses  of  the  Articles  of  the  Materia  Medica.     Second  edition,  revised  and  im- 


and  I 
tions 


proved,  with  a  Supplement  containing  the  most  important  New  Remedies.  With  copious  Addi 
lions,  and  two  hundred  and  thirteen  large  wood-engravings.  By  11.  Eglesfeld  Griffith,  M.  D. 
In  one  very  large  and  handsome  octavo  volume,  of  over  1000  pages. 


It  is  not  needful  that  w,  should  compare  it  with 
the  other  pharmacopoeias  extant,  which  enjoy  and 
merit  the  confidence  of  the  profession  :  it  is  enough 
to  say  that  it  appears  to  us  as  perfect  as  a  Dispensa- 
tory, in  the  present  state  of  pharmaceutical  science, 
could  be  made.  If  it  omits  any  details  pertaining  to 
this  branch  of  knowledge  which  the  student  has  a 
right  to  expect  in  such  a  work,  we  confess  the  omis- 
sion has  escaped  our  scrutiny.  We  cordially  recom- 
mend this  work  to  such  of  our  readers  as  are  in  need 
of  a  Dispensatory.  They  cannot  make  choice  of  a 
better. — Western  Journ.  of  Medicine  and  Surgery. 


There  is  not  in  any  language  a  more  complete  and 
perfect  Treatise. — A'.  Y.  Annalist. 

In  conclusion,  we  need  scarcely  say  that  we 
strongly  recommend  this  work  to  all  classes  of  our 
readers.  Asa  Dispensatory  and  commentary  on  the 
Pharmacopoeias,  it  is  unrivalled  in  the  English  or 
any  other  language. —  The  Dublin  Quarterly  Journal. 

We  earnestly  recommend  Dr.  Christison's  Dis- 
pensatory to  all  our  readers,  as  an  indispensable 
companion,  not  in  the  Study  only,  but  in  the  Surgery 
also. — British  and  Foreign  Medical  llevteto. 


BLANCHARD  &  LEA'S  MEDICAL 


CONDIE  (D.  F.),  M.  D.,  &c. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN.    Fourth 

edition,  revised  and  augmented.  In  one  large  volume,  8vo.,  of  nearly  750  pages.  {Lately  Issued.) 
From  the  Author's  Preface. 

The  demand  for  another  edition  has  afforded  the  author  an  opportunity  of  again  subjecting  the 
entire  treatise  to  a  careful  revision,  and  of  incorporating  in  it  every  important  observation  recorded 
since  the  appearance  of  the  last  edition,  in  reference  to  the  pathology  and  therapeutics  of  the  several 
diseases  of  which  it  treats. 

In  the  preparation  of  the  present  edition,  as  in  those  which  have  preceded,  while  the  author  has 
appropriated  to  his  use  every  important  fact  that  he  has  found  recorded  in  the  works  of  others, 
having  a  direct  bearing  upon  either  of  the  subjects  of  which  he  treats,  and  the  numerous  valuable 
observations — pathological  as  well  as  practical — dispersed  throughout  the  pages  of  the  medical 
journals  of  Europe  and  America,  he  has,  nevertheless,  relied  chiefly  upon  his  own  observations  and 
experience,  acquired  during  a  long  and  somewhat  extensive  practice,  and  under  circumstances  pe- 
culiarly well  adapted  for  the  clinical  study  of  the  diseases  of  early  life. 

Every  species  of  hypothetical  reasoning  has,  as  much  as  possible,  been  avoided.  The  author  has 
endeavored  throughout  the  work  to  confine  himself  to  a  simple  statement  of  well-ascertained  patho- 
logical facts,  and  plain  therapeutical  directions — his  chief  desire  being  to  render  it  what  its  title 
imports  it  to  be,  a  practical  treatise  on  the  diseases  of  children. 

Dr.  Condie's  scholarship,  acumen,  industry,  and 
practical  sense  are  manifested  in  this,  as  in  all  his 
numerous  contributions  to  science. — Dr.  Holmes's 
Report  to  the  American  Medical  Association. 

Taken  as  a  whole,  in  our  judgment,  Dr.  Condie's 
Treatise  is  the  one  from  the  perusal  of  which  the 
practitioner  in  this  country  will  rise  with  the  great- 
est satisfaction  — Western  Journal  of  Medicine  and 
Surgery. 

One  of  the  best  works  upon  the  Diseases  of  Chil- 
dren in  the  English  language. — Western  Lancet. 

Perhaps  the  most  full  and  complete  work  now  be- 
fore the  profession  of  the  United  States;  indeed,  we 
may  say  in  the  English  language.  It  is  vastly  supe- 
rior to  most  of  its  predecessors. — Transylvania  Med. 
Journal. 


We  feel  assured  from  actual  experience  that  no 
physician's  library  can  be  complete  without  a  copy 
of  this  work. — N.  Y.  Journal  of  Medicine. 

A  veritable  pediatric  encyclopaedia,  and  an  honor 
to  American  medical  literature. — Ohio  Medical  and 
Surgical  Journal. 

We  feel  persuaded  that  the  American  medical  pro- 
fession will  soon  regard  it  not  only  as  a  very  good, 
but  as  the  very  best  "Practical  Treatise  on  the 
Diseases  of  Children." — American  Medical  Journal. 

We  pronounced  the  first  edition  to  be  the  best 
work  on  the  diseases  of  children  in  the  English 
language,  and,  notwithstanding  all  that  has  been 
published,  we  still  regard  it  in  that  light. — Medical 
Examiner. 


COOPER  (BRANSBY  B.),  F.  R.  S., 

Senior  Surgeon  to  Guy's  Hospital,  &c. 

LECTURES  ON  THE   PRINCIPLES   AND    PRACTICE   OF   SURGERY. 

In  one  very  large  octavo  volume,  of  750  pages.    {Lately  Issued.) 


For  twenty-five  years  Mr.  Bransby  Cooper  has 
been  surgeon  to  Guy's  Hospital;  and  the  volume 
before  us  may  be  said  to  consist  of  an  account  of 
the  results  of  his  surgical  experience  during  that 
long  period.    We  cordially  recommend  Mr.  Bransby 


Cooper's  Lectures  as  a  most  valuable  addition  to 
our  surgical  literature,  and  one  which  cannot  fail 
to  be  of  service  both  to  students  and  to  those  who 
are  actively  engaged  in  the  practice  of  their  profes- 
sion.— The  Lancet. 


COOPER  (SIR  ASTLEY   P.),   F.  R.  S.,  &c. 
A  TREATISE  ON  DISLOCATIONS  AND  FRACTURES  OF  THE  JOINTS. 

Edited  by  Bransby  B.  Cooper,  F.  R.  S.,  &c.  With  additional  Observations  by  Prof.  J.  C. 
Warren.  A  new  American  edition.  In  one  handsome  octavo  volume,  of  about  500  pages,  with 
numerous  illustrations  on  wood. 

BY   THE   SAME   AUTHOR. 

ON  THE  ANATOMY  AND  TREATMENT  OF  ABDOMINAL  HERNIA. 

One  large  volume,  imperial  8vo.,  with  over  130  lithographic  figures. 

BY   THE   SAME    AUTHOR. 

ON   THE   STRUCTURE   AND  DISEASES    OF  THE  TESTIS,  AND  ON 

THE  THYMUS  GLAND.     One  vol.  imperial  8vo.,  with  177  figures,  on  2d  plates. 

BY   THE   SAME   AUTHOR. 

ON  THE  ANATOMY  AND  DISEASES  OF  THE  BREAST,  with  twenty- 

five  Miscellaneous  and  Surgical  Papers.     One  large  volume,  imperial  8vo.,  with  252  figures,  on 

36  plates. 

These  last  three  volumes  complete  the  surgical  writings  of  Sir  Astley  Cooper.  They  are  very 
handsomely  printed,  with  a  large  number  of  lithographic  plates,  executed  in  the  best  style,  and  are 
preseuted  at  exceedingly  low  prices. 


CARSON   (JOSEPH),  M.  D., 

Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania. 

SYNOPSIS  OF  THE  COURSE  OF  LECTURES  ON  MATERIA  MEDICA 

AND  PHARMACY,  delivered  in  the  University  of  Pennsylvania.     Second  and  revised   edi- 
tion.    In  one  very  neat  octavo  volume,  of  208  pages.     {Note  Heady.) 


AND    SCIENTIFIC    PUBLICATIONS. 


CHURCHILL  (FLEETWOOD),  M.  D.,  M.  R.  I.  A. 
ON  THE  THEORY  AND  PRACTICE  OP  MIDWIFERY.  A  new  American, 

from  (he  last  and  improved  English  edition.  Edited,  with  Notes  and  Additions,  by  D.  Francis 
Condie,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Children,"  &c.  With  139 
illustrations.    In  one  very  handsome  octavo  volume,  pp.  510.     {Lately  Issued.) 


To  bestow  prai  se  on  a  book  that  has  received  such 
marked  approbation  would  be  superfluous.  We  need 
only  say,  therefore,  that  if  the  first  edition  was 
thought  worthy  of  a  favorable  reception  by  the 
medical  public,  we  can  confidently  affirm  that  this 
will  be  found  much  more  so.  The  lecturer,  the 
practitioner,  and  the  student,  may  all  have  recourse 
to  its  pages,  and  derive  from  their  perusal  much  in- 
terest and  instruction  in  everything;  relating  to  theo- 
retical and  practical  midwifery. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  work  of  very  great  merit,  and  such  as  we  can 
confidently  recommend  to  the  study  of  every  obste- 
tric practitioner. — London  Medical  Gazette. 

This  is  certainly  the  most  perfect  system  extant. 
It  is  the  best  adapted  for  the  purposes  of  a  text- 
book, and  that  which  he  whose  necessities  confine 
him  to  one  book,  should  select  in  preference  to  all 
others. — Southern  Medical  and  Surgical  Journal. 

The  most  popular  work  on  midwifery  ever  issued 
from  the  American  press. — Charleston  Med.  Journal. 

Were  we  reduced  to  the  necessity  of  having  but 
one  work  on  midwifery,  and  permitted  to  choose, 
we  would  unhesitatingly  take  Churchill. —  Western 
Med.  and  Surg.  Journal. 

It  is  impossible  to  conceive  a  more  useful  and 
elegant  manual  than  Dr.  Churchill's  Practice  of 
Midwifery. — Provincial  Medical  Journal. 

Certainly,  in  our  opinion,  the  very  best  work  on 
the  subject  which  exists. — N.  Y.  Annalist. 


No  work  holds  a  higher  position,  or  is  more  de- 
serving of  being  placed  in  the  hands  of  the  tyro, 
the  advanced  student,  or  the  practitioner. — Medical 
Examiner. 

Previous  editions,  under  the  editorial  supervision 
of  Prof  R.  M.  Huston,  have  been  received  with 
marked  favor,  and  they  deserved  it;  but  this,  re- 
printed from  a  very  late  Dublin  edition,  carefully 
revised  and  brought  up  by  the  author  to  the  present 
time,  does  present  an  unusually  accurate  and  able 
exposition  of  every  important  particular  embraced 
in  the  department  of  midwifery.  *  *  The  clearness, 
directness,  and  precision  of  its  teachings,  together 
with  the  great  amount  of  statistical  research  which 
its  text  exhibits,  have  served  to  place  it  already  in 
the  foremost  rank  of  works  in  this  department  of  re- 
medial science. — N.  O.  Med.  and  Surg.  Journal. 

In  our  opinion,  it  forms  one  of  the  best  if  not  the 
very  best  text-book  and  epitome  of  obstetric  science 
which  we  at  present  possess  in  the  English  lan- 
guage.—  Monthly  Journal  of  Medical  Science. 

The  clearness  and  precision  of  style  in  which  it  is 
written,  and  the  great  amount  of  statistical  research 
which  it  contains,  have  served  to  place  it  in  the  first 
rank  of  works  in  this  departmentof  medical  science. 
—  N.  Y.  Journal  of  Medicine. 

Few  treatises  will  be  found  better  adapted  as  a 
text-book  for  the  student,  or  as  a  manual  for  the 
frequent  consultation  of  the  young  practitioner. — 
American  Medical  Journal. 


BY   THE   SAME   AUTHOR. 


ON  THE.  DISEASES  OF  INFANTS  AND  CHILDREN.     In  one  large  and 


handsome  volume  of  over  600  pages. 

We  regard  this  volume  as  possessing  more  claims 
to  completeness  than  any  other  of  the  kind  with 
which  we  are  acquainted.  Most  cordially  and  earn- 
estly, therefore,  do  we  commend  it  to  our  profession- 
al brethren,  and  we  feel  assured  that  the  stamp  of 
their  approbation  will  in  due  time  be  impressed  upon 
it.  After  an  attentive  perusal  of  its  contents,  we 
hesitate  not  to  say,  that  it  is  one  of  the  most  com- 
prehensive ever  written  upon  the  diseases  of  chil- 
dren, and  that,  for  copiousness  of  reference,  extentof 
research,  and  perspicuity  of  detail,  it  is  scarcely  to 
be  equalled,  and  not  to  be  excelled,  in  any  lan- 
guage.— Dublin  Quarterly  Journal. 

After  this  meagre,  and  we  know,  very  imperfect 
notice  of  Dr.  Churchill's  work,  we  snail  conclude 
by  saying,  that  it  is  one  that  cannot  fail  from  its  co- 
piousness, extensive  research,  and  general  accuracy, 
to  exalt  still  higher  the  reputation  of  the  author  in 
this  country.  The  American  reader  will  be  particu- 
larly pleased  to  find  that  Dr.  Churchill  has  done  full 
justice  throughout  his  work  to  the  various  American 
authors  on  this  subject.  The  names  of  Dewees, 
Eberle,  Condie,  and  Stewart,  occur  on  nearly  every 
page,  and  these  authors  are  constantly  referred  to  by 
the  author  in  terms  of  the  highest  praise,  and  with 
the  most  liberal  courtesy. —  The  Medical  Examiner. 


The  present  volume  will  sustain  the  reputation 
acquired  by  the  author  from  his  previous  works. 
The  reader  will  find  in  it  full  and  judicious  direc- 
tions for  the  management  of  infants  at.  birth,  and  a 
compendious,  but  clear  account  of  the  diseases  to 
which  children  are  liable,  and  the  most  successful 
mode  of  treating  them.  We  must  not  close  this  no- 
tice without  calling  attention  to  the  author's  style, 
which  is  perspicuous  and  polished  to  a  degree,  we 
regret  to  say,  not  generally  characteristic  of  medica. 
works.  We  recommend  the  work  of  Dr.  Churchill 
most  cordially,  both  to  students  and  practitioners, 
as  a  valuable  and  reliable  guide  in  the  treatment  of 
the  diseases  of  children. — Am.  Journ.  of  the  Med. 
Sciences. 

We  know  of  no  work  on  this  department  of  Prac- 
tical Medicine  which  presents  so  candid  and  unpre- 
judiced a  statement  or  posting  up  of  our  actual 
knowledge  as  this. — N.  Y.  Journal  of  Medicine. 

Its  claims  to  merit  both  as  a  scientific  and  practi- 
cal work,  are  of  the  highest  order.  Whilst  we 
would  not  elevate  it  above  every  other  treatise  on 
the  same  subject,  we  certainly  believe  that  very  few 
are  equal  to  it,  and  none  superior. — Southern  Med. 
and  Surgical  Journal. 


BY   THE  SAME   AUTHOR. 


ESSAYS  ON  THE  PUERPERAL  FEVER,  AND  OTHER  DISEASES  PE- 
CULIAR TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previous  to  the  close  of 
the  Eighteenth  Century.    In  one  neat  octavo  volume,  of  about  four  hundred  and  fifty  pages. 


To  these  papers  Dr.  Churchill  has  appended  notes, 
embodying  whatever  information  has  been  laid  be- 
fore the  profession  since  their  authors' time.  He  has 
also  prefixed  to  the  Essays  on  Puerperal  Fever, 
which  occupy  the  larger  portion  of  the  volume,  an 
interesting   historical  sketch  of  the  principal  epi- 


demics of  that  disease.  The  whole  forms  a  very 
valuable  collection  of  papers,  by  professional  writers 
of  eminence,  on  some  of  the  most  important  accident! 
to  which  the  puerperal  female  is  liable. — American 
Journal  of  Medical  Sciences. 


10 


BLANCHARD    &    LEA'S    MEDICAL 


CHURCHILL  (FLEETWOOD),    M.  D.,  M.  R.  I.  A.,    &c. 

ON  THE  DISEASES  OF  WOMEN;  including  those  of  Pregnancy  and  Child- 
bed.   A  new  American  edition,  revised  by  the  Author.    With  Notes  and  Additions,  by  D  Fran- 
cis Condie,  M.  D.,  author  of  "A  Practical  Treatise  on  the.  Diseases  of  Children."    In  one  large 
and  handsome  octavo  volume,  with  wood-cuts,  pp.  684.     [Just  Issued.) 
We  now  regretfully  take,  leave  of  Dr.  Churchill's 


book.  Had  our  typographical  limits  permitted,  we 
should  gladly  have  borrowed  more  from  its  richly 
stored  pages.  In  conclusion,  wo  heartily  recom- 
mend it  to  the  profession,  and  would  at  the  same 
time  express  our  firm  conviction  that  it  will  not  only 
add  to  the  reputation  of  its  author,  but  will  prove  a 
work  of  great  and  extensive  utility  to  obstetric 
practitioners. — Dublin  Medical  Press. 

Former  editions  of  this  work  have  been  noticed  in 
previous  numbers  of  the  Journal.  The  sentiments  of 
high  commendation  expressed  in  those  notices,  have 
only  to  be  repeated  in  this;  not  from  the  fact  that 
the  profession  at  large  are  not  aware  of  the  high 
merits  which  this  work  really  possesses,  but  from  a 
desire  to  see  the  principles  and  doctrines  therein 
contained  more  generally  recognized,  and  more  uni- 
versally carried  out  in  practice. — N.  Y.  Journal  of 
Medicine. 

We  know  of  no  author  who  deserves  that  appro- 
bation, on  "  the  diseases  of  females,"  to  the  same 
txrent  that  Dr.  Churchill  does.  His,  indeed,  is  the 
only  thorough  treatise  we  know  of  on  the  subject; 
and  it  may  be  commended  to  practitioners  and  stu- 
dents as  a  masterpiece  in  its  particular  department. 
The  former  editions  of  this  work  have  been  com- 
mended strongly  in  this  journal,  and  they  have  won 
their  way  to  an  extended,  and  a  well-deserved  popu- 


larity. This  fifth  edition,  before  us.  is  well  calcu- 
lated to  maintain  Dr.  Churchill's  high  reputation. 
It  was  revised  and  enlarged  by  the  author,  for  his 
American  publishers,  and  it  seems  to  us  that  there  is 
scarcely  any  species  of  desirable  information  on  its 
subjects  that  may  not  be  found  in  this  work. — The 
Western  Journal  of  Medicine  and  Surgery. 

AVe  are  gratified  to  announce  a  new  and  revised 
edition  of  Dr.  Churchill's  valuable  work  on  the  dis- 
eases of  females  We  have  ever  regarded  it  as  one 
of  the  very  best  works  on  the  subjects  embraced 
within  its  scope,  in  the  English  language;  and  the 
present  edition,  enlarged  and  revised  by  the  author, 
renders  it  still  more  entitled  to  the  confidence  of  the 
profession.  The  valuable  notes  of  Prof.  Huston 
have  been  retained,  and  contribute,  in  no  small  de- 
gree, to  enhance  the  value  of  the  work.  It  is  a 
source  of  congratulation  that  the  publishers  have 
permitted  the  author  to  be,  in  this  instance,  his 
own  editor,  thus  securing  all  the  revision  which 
an  author  alone  is  capable  of  making. —  The  Western 
Lancet. 

Asa  comprehensive  manual  for  students,  or  a 
work  of  reference  for  practitioners,  we  only  speak 
with  common  justice  when  we  say  that  it  surpasses 
any  other  that  has  ever  issued  on  the  same  sub- 
ject from  the  British  press. —  The  Dublin  Quarterly 
Journal. 


DICKSON   (S.    H.),    M.  D., 

Professor  of  Institutes  and  Practice  of  Medicine  in  the  Medical  College  of  South  Carolina. 

ELEMENTS  OF  MEDICINE;    a  Compendious  View  of  Pathology  and  Thera- 

petitics,  or  ihe  History  and  Treatment  of  Diseases.     In  one  large  and  handsome  octavo  volume 

of  nearly  800  pages      (Noiv  Ready.) 

As  a  text- book  on  the  Practice  of  Medicine  for  the  student,  and  as  a  condensed  work  of  reference 
for  the  practitioner,  this  volume  will  have  strong  claims  on  the  attention  of  the  American  profession. 
Few  physicians  have  had  wider  opportunities,  than  the  author,  for  observation  and  experience,  and 
few  perhaps  have  used  them  belter.  As  the  result  of  a  life  of  study  and  practice,  therefore,  the 
present  volume  will  doubtless  be  received  with  the  welcome  it  deserves. 

From  the  Preface. 

Tffe  present  volume  is  inlended  as  an  aid  to  young  men  who  have  engaged  in  the  study  of  medi- 
cine, to  physician-;  who  have  recently  assumed  the  responsibilities  of  practice,  and  to  my  fellow 
professors  of  the  Institutes  of  Medicine,  and  private  instructors  who  have  felt  the  difficulty  of  com- 
municating to  the  two  (irst  classes  the  knowledge  which  they  are  earnestly  seeking  to  acquire. 
Having  been  a  teacher  of  medicine  for  thirty  years,  and  a  student  more  than  forly,  I  must  have 
accumulated  some  experience  in  both  characters.  I  have  prepared  and  printed  for  those  in  attend- 
ance on  my  lectures  many  successive  manuals  or  text-books.  I  have  also  written  and  published 
several  volumes  on  medical  subjects  in  general.  The  following  pages  are  ihe  result  of  a  careful 
collation  of  all  that  has  been  esteemed  valuable  in  bolh,  with  such  matter  as  continued  study  and 
enlarged  experience  has  enabled  me  to  add. 


DEWEES   (W.    P.),   M.D.,    &c. 
A   COMPREHENSIVE   SYSTEM  OF   MIDWIFERY.     Illustrated   by   occa- 

sional  Cases  and  many  Engravings.     Twelfth  edition,  with  the  Author's  last  Improvements  and 
Corrections.     In  one  octavo  volume,  of  600  pages.     (Just  Issued.) 

BY   THE   SAME   AUTHOR. 

A  TREATISE  ON  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF 

CHILDREN.     Tenth  edition.     In  one  volume,  octavo,  548  pages.     (Just  Issued.) 


BY   THE    SAME   AUTHOR. 


A  TREATISE  ON   THE  DISEASES   OF   FEMALES. 

one  volume,  octavo,  532  pages,  with  plates.     (Just  Issued.) 


Tenth   edition.     In 


DANA    (JAMES     D). 
ZOOPHYTES  AND  CORALS.     In  one  volume,  imperial  quarto,  extra  cloth, 

with  wood-cuts.     Also,  AN  ATLAS,-  in  one  volume,  imperial  folio,  with  sixty-one  magnificent 
plates,  colored  after  nature.     Bound  in  half  morocco. 


DE    LA    BECHE   (SIR 
THE  GEOLOGICAL  OBSERVER 

volume,  of  700  pages.     With  over  three  hundred  wood-cuts 


HENRY    T.),   F.  R.  S.,  &c. 

In  one  very  large   and   handsome  octavo 
(Lately  Issued.) 


AND    SCIENTIFIC    PUBLICATIONS. 


a! 


DRUITT   (ROBERT),   M.R.  C.S.,   &c. 
THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY.     A  new 

American,  from,  the  improved  London  edition.  Edited  by  F.  W.  Sargent,  M.  D.,  author  of 
"Minor  Surgery,"  &c.  Illustrated  with  one  hundred  and  ninety-three  wood-engravings.  In 
one  very  handsomely  printed  octavo  volume,  of  576  large  pages. 

Dr.  Druitt's  researches  into  the  literature  of  his  I  is  really  practically  useful  at  the  bedside  will  be 
ubject  have  been  not  only  extensive,  but  well  di-     found  in  a  form  at  once  clear,  distinct,  and  interest- 


rected  ;  the  most  discordant  authors  are  fairly  and 
impartially  quoted,  and,  while  due  credit  is  given 
to  each,  their  respective  merits  are  weighed  with 
an  unprejudiced  hand.  The  grain  of  wheat  is  pre- 
served, and  the  chaff  is  unmercifully  stripped  off. 
The  arrangement  is  simple  and  philosophical,  and 
the  style,  though  clear  and  interesting,  is  so  precise, 
that  the  book  contains  more  information  condensed 
into  a  few  words  than  any  other  surgical  work  with 
which  we  are  acquainted. — London  Medical  Times 
and  Gazette,  February  18,  1S5I. 

No  work,  in  our  opinion,  equals  it  in  presenting 
so  much  valuable  surgical  matter  in  so  small  a 
compass. — St.  Louis  Med.  and  Surgical  Journal. 

Druitt's  Surgery  is  too  well  known  to  the  Ameri- 
can medical  profession  to  require  its  announcement 
anywhere.  Probably  no  work  of  the  kind  has  ever 
been  more  cordially  received  and  extensively  circu- 
lated than  this.  The  fact  that  it  comprehends  in  a 
comparatively  small  compass,  all  the  essential  ele- 
ments of  theoretical  and  practical  Surgery — that  it 
is  found  to  contain  reliable  and  authentic  informa- 
tion on  the  nature  and  treatment  of  nearly  all  surgi- 
cal atfections — is  a  sufficient  reason  for  the  liberal 
patronage  it  has  obtained.  The  editor,  Dr.  F.  W. 
Sargent,  has  contributed  much  to  enhance  the  value 
of  the  work,  by  such  American  improvements  as  are 
calculated  more  perfectly  to  adapt  it  to  our  own 
views  and  practice  in  this  country.  It  abounds 
everywhere  with  spirited  and  life-like  illustrations, 
which  to  the  young  surgeon,  especially,  are  of  no 
minor  consideration.  Every  medical  man  frequently 
needs  just  such  a  work  as  this,  for  immediate  refe- 
rence in  moments  of  sudden  emergency,  when  he  has 
not  time  to  consult  more  elaborate  treatises. — The 
Ohio  Medical  and  Surgical  Journal. 

The  author  has  evidently  ransacked  every  stand- 
ard treatise  of  ancient  and  modern  times,  and  all  that 


ing. — Edinburgh  Monthly  Medical  Journal. 

Druitt's  work,  condensed,  systematic,  lucid,  and 
practical  as  it  is,  beyond  most  works  on  Surgery 
accessible  to  the  American  student,  has  had  much 
currency  in  this  country,  and  under  its  present  au- 
spices promises  to  rise  to  yet  higher  favor. — The 
Western  Journal  of  Medicine  and  Surgery. 

The  most  accurate  and  ample  resume  of  the  pre- 
sent state  of  Surgery  that  we  are  acquainted  with. — 
Dublin  Medical  Journal. 

A  better  book  on  the  principles  and  practice  of 
Surgery  as  now  understood  in  England  and  America, 
has  not  been  given  to  the  profession. — Boston  Mtdi- 
cal  and  Surgical  Journal. 

An  unsurpassable  compendium,  not  only  of  Sur- 
gical, but  of  Medical  Practice. — London  Medical 
Gazette. 

This  work  merits  our  warmest  commendations, 
and  we  strongly  recommend  it  to  young  surgeons  as 
an  admirable  digest  of  the  principles  and  practice  of 
modern  Surgery. — Medical  Gazette. 

It  maybe  said  with  truth  that  the  work  of  Mr. 
Druitt  affords  a  complete,  though  brief  and  con- 
densed view,  of  the  entire  field  of  modern  surgery. 
We  know  of  no  work  on  the  same  subject  having  the 
appearance  of  a  manual,  which  includes  so  many 
topics  of  interest  to  the  surgeon  ;  and  the  terse  man- 
ner in  which  each  has  been  treated  evinces  a  most 
enviable  quality  of  mind  on  the  part  of  the  author, 
who  seems  to  have  an  innate  power  of  searching 
out  and  grasping  the  leading  facts  and  features  of 
the  most  elaborate  productions  of  the  pen.  It  is  a 
useful  handbook  for  the  practitioner,  and  we  should 
deem  a  teacher  of  surgery  unpardonable  who  did  not 
recommend  it  to  his  pupils.  In  our  own  opinion,  it 
is  admirably  adapted  to  the  wants  of  the  student. — 
Provincial  Medical  and  Surgical  Journal. 


DUNGLISON,    FORBES,   TWEEDIE,    AND   CONOLLY. 
THE  CYCLOPAEDIA  OF  PRACTICAL  MEDICINE:  comprising  Treatises  on 

the  Nature  and  Treatment  of  Diseases,  Materia  Medica,  and  Therapeutics,  Diseases  of  Women 
and  Children,  Medical  Jurisprudence,  &c.  &c.  In  four  large  super  royal  octavo  volumes,  of 
3254  double-columned  pages,  strongly  and  handsomely  bound. 

*#*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed  by 
eix-ty-eighl  distinguished  physicians. 


The  most  complete  work  on  Practical  Medicine 
extant;  or,  at  least,  in  our  language.—  Buffalo 
Medical  and  Surgical  Journal. 

For  reference,  it  is  above  all  price  to  every  prac- 
titioner.—  Western  Lancet. 

One  of  the  most  valuable  medical  publications  of 
the  day — as  a  work  of  reference  it  is  invaluable. — 
Western  Journal  of  Medicine  and  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  one  in  which 
modern  English  medicine  is  exhibited  in  the  most 
advantageous  light. — Medical  Examiner. 

We  rejoice  that  this  work  is  to  be  placed  within 
the  reach  of  the  profession  in  this  country,  it  being 


unquestionably  one  of  very  great  value  to  the  prac- 
titioner. This  estimate  of  it  has  not  been  formed 
from  a  hasty  examination,  but  after  an  intimate  ac- 
quaintance derived  from  frequent  consultation  of  it 
during  the  past  nine  or  ten  years.  The  editors  are 
practitioners  of  established  reputation,  and  the  list 
of  contributors  embraces  many  of  the  most  eminent 
professors  and  teachers  of  London,  Edinburgh,  Dub- 
lin, and  Glasgow.  It  is,  indeed,  the  great  merit  of 
this  work  that  the  principal  articles  have  been  fur- 
nished by  practitioners  who  have  not  only  devoted 
especial  attention  to  the  diseases  about  which  they 
have  written,  but  have  also  enjoyed  opportunities 
for  an  extensive  practical  acquaintance  with  them, 
and  whose  reputation  carries  the  assurance  of  their 
competency  justly  to  appreciate  the  opinions  of 
others,  while  it  stamps  their  own  doctrines  with 
high  and  just  authority. — American  Medical  Journ. 


DUNGLISON    (ROBLEY),    M.D., 
Professor  of  the  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN  HEALTH;   or,  the  Influence  of  Atmosphere  and  Locality,  Change  of 

Air  and  Climate,  Seasons,  Food,  Clothing,  Bathing,  Exercir-e,  Sleep,  fee.  &0  ,  on  Healthy  Man  ; 
constituting  Elements  of  Hygiene.  Second  edition,  with  many  modifications  and  additions.  In 
one  octavo  volume,  of  464  pages. 


12 


BLANCHARD   &    LEA'S    MEDICAL 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

MEDICAL   LEXICON;   a  Dictionary  of  Medical  Science,  containing  a  concise 

Explanation  of'the  various  Subjects  and  Terms  of  Physiology,  Pathology,  Hygiene,  Therapeutics, 
Pharmacology,  Obstetrics,  Medical  Jurisprudence,  &c.  Wilh  the  French  and  other  Synonymes; 
Notices  of  Climate  and  of  celebrated  Mineral  Waters;  Formulae  for  various  Officinal,  Empirical, 
and  Dietetic  Preparations,  etc.  Twelfth  edition,  revised.  In  one  very  thick  octavo  volume,  ot 
over  nine  hundred  large  double-columned  pages,  strongly  bound  in  leather,  with  raised  bands. 
(Just  Issued.) 

Every  successive  edition  of  this  work  bears  the  marks  of  the  industry  of  the  author,  and  of  his 
determination  to  keep  it  fully  on  a  level  with  the  most  advanced  state  of  medical  science.  Thus 
nearly  fifteen  thousand  words  have  been  added  to  it  within  the  last  few  vears.  As  a  complete 
Medical  Dictionary,  therefore,  embracing  over  FIFTY  THOUSAND  DEFINITIONS,  in  all  the 
branches  of  the  science,  it  is  presented  as  meriting  a  continuance  of  the  great  favor  and  popularity 
which  have  carried  it,  within  no  very  long  space  of  time,  to  a  twelfth  edition. 

Every  precaution  has  been  taken  in  the  preparation  of  the  present  volume,  to  render  its  mecha- 
nical execution  and  typographical  accuracy  worthy  of  its  extended  reputation  and  universal  use. 
The  very  extensive  additions  have  been  accommodated,  without  materially  increasing  the  bulk  of 
the  volume  by  the  employment  of  a  small  but  exceedingly  clear  type,  cast  for  this  purpose.  The 
press  has  been  watched  with  great  care,  and  every  effort  used  to  insure  the  verbal  accuracy  so  ne- 
cessary  to  a  work  of  this  nature.  The  whole  is  printed  on  fine  white  paper  ;  and,  while  thus  exhi- 
biting in  every  respect  so  great  an  improvement  over  former  issues,  it  is  presented  at  the  original 
exceedingly  low  price. 


We  welcome  it  cordially  ;  it  is  an  admirable  work, 
and  indispensable  to  all  literary  medical  men.  The 
labor  which  has  been  bestowed  upon  it  is  something 
prodigious.  The  work,  however,  has  now  been 
done,  and  we  are  hnppy  in  the  thought  that  no  hu- 
man bring  will  have  again  to  undertake  the  same 
gigantic  task.  Revised  and  corrected  from  time  to 
time,  Dr.  Dunglison's  "  Medical  Lexicon"  will  last 
for  centuries. — British  and  Foreign  Med.  Chirurg. 
Review. 

The  fact  that  this  excellent  and  learned  work  has 
passed  through  eight  editions,  and  that  a  ninth  is 
rendered  necessary  by  the  demands  of  the  public, 
affords  a  sufficient  evidence  of  the  general  apprecia- 
tion of  Dr.  Dunglison's  labors  by  the  medical  pro- 
fession in  England  and  America.  It  is  a  book  which 
will  be  of  great  service  to  the  student,  in  teaching 
him  the  meaning  of  all  the  technical  terms  used  in 
medicine,  and  will  be  of  no  less  use  to  the  practi- 
tioner who  desires  to  keep  himself  on  a  level  with 
the  advance  of  medical  science. — London  Medical 
Times  and  Gazette. 

In  taking  leave  of  our  author,  we  feel  compelled 
to  confess  that  his  work  bears  evidence  of  almost 
incredible  labor  having  been  bestowed  upon  its  com- 
position.—  Edinburgh  Journal  of  Med.  Sciences. 
A  miracle  of  labor  and  industry  in  one  who  has 
written  able  and  voluminous  works  on  nearly  every 
branch  of  medical  science.  There  could  be  no  more 
useful  book  to  the  student  or  practitioner,  in  the 
present  advancing  age,  than  one  in  which  would  be 
found,  in  addition  to  the  ordinary  meaningand  deri- 
vation of  medical  terms — so  many  of  which  are  of 
modern  introduction — concise  descriptions  of  their 
explanation  and  employment;  and  all  this  and  much 
more  is  contained  in  the  volume  before  us.  It  is 
therefore  almost  as  indispensable  to  the  other  learned 
professions  as  to  our  own.  In  fact,  to  all  who  may 
have  occasion  to  ascertain  the  meaning  of  any  word 
belonging  to  the  many  branches  of  medicine.  From 
a  careful  examination  of  the  present  edition,  wecan 
vouch  for  its  accuracy,  and  for  its  being  brought 
quite  up  to  the  date  of  publication  ;  the  author  states 
in  his  preface  that  hehusadded  to  it  aboutfonr  thou- 
sand terms,  which  are  not  to  be  found  in  the  piece- 


readers  to  its  peculiar  merits;  and  we  need  do 
little  more  than  state,  in  reference  to  the  present 
reissue,  that,  notwithstanding  the  large  additions 
previously  made  to  it,  no  fewer  than  four  thou- 
sand terms,  not  to  be  found  in  the  preceding  edi- 
tion, are  contained  in  the  volume  hi  fore  us. — 
Whilst  it  is  a  wonderful  monument  of  its  author's 
erudition  and  industry,  it  is  also  a  work  of  great 
practical  utility,  as  we  can  testify  from  our  own 
experience;  for  we  keep  it  constantly  within  our 
reach,  and  make  very  frequent  reference  to  it, 
nearly  always  finding  in  it  the  information  we  seek. 
— British  and  Foreign  Med.-Chirurg.  Review. 

It  has  the  rare  merit  that  it  certainly  has  no  rival 
in  the  English  language  for  accuracy  and  extent 
of  references.  The  terms  generally  include  short 
physiological  and  pathological  descriptions,  so  that, 
as  the  author  justly  observes,  the  reader  does  not 
possess  in  this  work  a  mere  dictionary,  but  a  book, 
which,  while  it  instructs  him  in  medical  etymo- 
logy, furnishes  him  with  a  large  amount  of  useful 
information.  The  author's  labors  have  been  pro- 
perly appreciated  by  his  own  countrymen  ;  and  we 
can  only  confirm  their  judgment,  by  recommending 
this  most  useful  volume  to  the  notice  of  our  cisat- 
lantic readers.  No  medical  library  will  be  complete 
without  it. — London  Med.  Gazette. 

It  is  certainly  more  complete  and  comprehensive 
than  any  with  which  we  are  acquainted  in  the 
English  language.  Few,  in  fact,  could  be  found 
belter  qualified  than  Dr.  Dunglison  for  the  produc- 
tion of  such  a  work.  Learned,  industrious,  per- 
severing, and  accurate,  he  brings  to  the  task  all 
the  peculiar  talents  necessary  for  its  successful 
performance;  while,  at  the  same  time,  his  fami- 
liarity with  the  writings  of  the  ancient  and  modern 
'•  masters  of  our  art,"  renders  him  skilful  to  note 
the  exact  usage  of  the  several  terms  of  science, 
and  the  various  modifications  which  medical  term 
inology  has  undergone  with  the  change  of  theo- 
ries or  the  progress  of  improvement.  —  American 
Journal  of  the  Medical  Sciences. 

One  of  the  most  complete  and  copious  known  to 
the   cultivators  of  medical   science. — Boston  Med. 


ding   one.  —  Dublin  Quarterly  Journal  of  Medical    Journal. 
Sci-nc.s.  i      Tne  most  comprehensive  and  best  English  Die- 

On    the  appearance  of  the  last   edition   of   this  I  tionary  of  medical  terms  extant. — Buffalo  Medical 
valuable  work,   we   directed  the  attention  of  our  |  Journal. 


BY   THE   SAME   AUTHOR. 

THE  PKACTICE  OF  MEDICINE.     A  Treatise  on  Special  Pathology  and  The 

rapeuties.     Third  Edition.     In  two  large  octavo  volumes,  of  fifteen  hundred  pages. 

Upon  every  topic  embraced  in  the  work  the  latest 
information  will  be  found  carefully  posted  up. — 
Medical  Examiner . 


The  student  of  medicine  will  find,  in  these  two 
elegant  volumes,  a  mine  of  facts,  a  gathering  of 
precepts  and  advice  from  the  world  of  experience, 
that  will  nerve  nim  with  courage,  and  faithfully 
direct  him  in  his  efforts  to  relieve  the  physical  suf- 


ferings of  the  race.— Boston  Medical  and  Surgical 
Journal. 


It  is  certainly  the  most  complete  treatise  of  which 
we  haveany  knowledge. —  Western  Journal  of  Medi- 
cine and  Surgery. 

One  of  the  most  elaborate  treatises  of  the  kind 
we  have. — Southern  Med.  and  Surg.  Journal. 


AND    SCIENTIFIC    PUBLICATIONS. 


13 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN    PHYSIOLOGY.     Seventh   edition.     Thoroughly  revised   and  exten- 
sively modified  and  enlarged,  with  nearly  five  hundred  illustrations.     In  two  large  and  hand- 
somely printed  octavo  volumes,  containing  nearly  1450  pages. 
It  has  long  since  taken  rank  as  one  of  the  medi- 
cal classics  of  our  language.     To  say  that  it  is  by 
far  the  best  text-book  of  physiology  ever  published 


in  this  country,   is  but  echoing   the  general  testi- 
mony of  the  profession. — N.  Y.  Journal  of  Medicine . 

There  is  no  single  book  we  would  recommend  to 
the  student  or  physician,  with  greater  confidence 
than  the  present,  because  in  it  will  be  found  a  mir- 
ror of  almost  every  standard  physiological  work  of 
the  day.  We  most  cordially  recommend  the  work 
to  every  member  of  the  profession,  and  no  student 
should  be  without  it.    It  is  the  completest  work  on 


Physiology  in  the  English  language,  and  is  highly 
creditable  to  the  author  and  publishers.— Canadian 
Medical  Journal. 


The  most  complete  and  satisfactory  system  of 
Physiology  in  the  English  language. — Amer.  Med. 
Journal . 

The  best  work  of  the  kind  in  the  English  lan- 
guage.— Siliiman's  Journal. 

The  most  full  and  complete  system  of  Physiology 
in  our  language. —  Western  Lancet. 


BY  THE  SAME  author.     (Just  Issued.) 

GENEEAL    THERAPEUTICS    AND    MATERIA  MEDICA;   adapted  for  a 

Medical  Text-book.  Fifth  edition,  much  improved.  With  one  hundred  and  eighty-seven  illus- 
trations. In  two  large  and  handsomely  printed  octavo  vols.,  of  about  1100  pages. 
The  new  editions  of  the  United  States  Pharmacopoeia  and  those  of  London  and  Dublin,  have  ren- 
dered necessary  a  thorough  revision  of  this  work.  In  accomplishing  ibis  the  author  has  spared  no 
pains  in  rendering  it  a  complete  exponent  of  all  that  is  new  and  reliable,  both  in  the  departments 
of  Therapeutics  and  Materia  Medica.  The  book  has  thus  been  somewhat  enlarged,  and  a  like  im- 
provement will  be  found  in  every  department  of  its  mechanical  execution.  As  a  convenient  text- 
book for  the  student,  therefore,  containing  within  a  moderate  compass  a  satisfactory  resume  of  its 
important  subject,  it  is  again  presented  as  even  more  worthy  than  heretofore  of  the  very  great  favor 
which  it  has  received. 

As  a  text-book  for  students,  for  whom  it  is  par- 
ticularly designed,  we  know  of  none  superior  to 
it. — St.  Louis  Medical  and  Surgical  Journal. 


In  this  work  of  Dr.  Dunglison,  we  recognize  the 
same  untiring  industry  in  the  collection  and  em- 
bodying of  facts  on  the  several  subjects  of  which  he 
treats,  that  has  heretofore  distinguished  him,  and 
we  cheerfully  point  to  these  volumes,  as  two  of  the 
most  interesting  that  we  know  of.  In  noticing  the 
additions  to  this,  the  fourth  edition,  there  is  very 
little  in  the  periodical  or  annual  literature  of  the 
profession,  published  in  the  interval  which  has 
elapsed  since  the  issue  of  the  first,  that  has  escaped 
the  careful  search  of  the  author.  As  a  book  for 
reference,  it  is  invaluable. —  Charleston  Med.  Jour- 
nal and  Review. 

It  may  be  said  to  be  the  work  now  upon  the  sub- 
jects upon  which  it  treats. —  Western  Lancet. 


It  purports  to  be  a  new  edition,  but  it  is  rather 
a  new  book,  so  greatly  has  it  been  improved,  both 
in  the  amount  and  quality  of  the  matter  which  it 
contains. — iV.  O.  Medical  and  Surgical  Journal. 

We  bespeak  for  this  edition,  from  the  profession, 
an  increase  of  patronage  over  any  of  its  former 
ones,  on  account  of  its  increased  merit.  —  N.  Y. 
Journal  of  Medicine. 


We  consider  this  work  unequalled. 
and  Surg.  Journal. 


-Boston  Med. 


BY   THE   SAME   AUTHOR. 

NEW  REMEDIES,  WITH  FORMULA  FOR  THEIR  ADMINISTRATION. 

Sixth  edition,  with  extensive  Additions.     In  one  very  large  octavo  volume,  of  over  750  pages. 
One  of  the  most  useful  of  the  author's  works. —    diseases  and  for  remedies,  will  be  found  greatly  to 
Southern  Medical  and  Surgical  Journal.  enhance  its  value. — New  York  Med.  Gazette. 


This  well-known  and  standard  book  has  now 
reached  its  sixth  edition,  and  has  been  enlarged  and 
improved  by  the  introduction  of  all  the  recent  gifts 
to  therapeutics  which  the  last  few  years  have  so 
richly  produced,  including  the  anaesthetic  agents, 
&c.  This  elaborate  and  useful  volume  should  be 
found  in  every  medical  library,  for  as  a  book  of  re- 
ference, for  physicians,  it  is  unsurpassed  by  any 
other  work  in  existence,  and  the  double  index  for 


The  great  learning  of  the  author,  and  his  remark- 
able industry  in  pushing  his  researches  into  every 
source  whence  information  is  derivable,  has  enabled 
him  to  throw  together  an  extensive  mass  of  facts 
and  statements,  accompanied  by  full  reference  to 
authorities;  which  last  feature  renders  the  work 
practically  valuable  to  investigators  who  desire  to 
examine  the  original  papers. — The  American  Journal 
of  Pharmacy. 


DE  JONGH  (L.  J.),  M.  D.,  &c. 
THE  THREE  KINDS   OF  COD-LIVER  OIL,  comparatively  considered,  with 

their  Chemical  and  Therapeutic  Properties.  Translated,  with  an  Appendix  and  Cases,  by 
Edward  Carey,  M.  D.  To  which  is  added  an  article  on  the  subject  from  "Dunglison  on  New 
Remedies."     In  one  small  12mo.  volume,  extra  cloth. 


DAY  (GEORGE  E.),  M .  D. 
A  PRACTICAL  TREATISE  ON  THE  DOMESTIC  MANAGEMENT  AND 

MORE  IMPORTANT  DISEASES  OF  ADVANCED  LIFE.  With  an  Appendix  on  a  new 
and  successful  mode  of  treating  Lumbago  and  other  lorms  of  Chronic  Rheumatism.  One  volume, 
octavo,  226  pages. 


FRICK  (CHARLES),  M.  D. 
RENAL    AFFECTIONS;    their  Diagnosis  and  Pathology. 

One  volume,  royal  12mo.,  extra  cloth. 


With  illustrations. 


14 


BLANCHARD    &    LEA'S    MEDICAL 


ERICHSEN    (JOHN), 
Professor  of  Surgery  in  University  College,  London,  &c. 

THE  SCIENCE  AND  ART  OP  SURGERY;  being  a  Treatise  on  Surgical 

Injuries,  Diseases,  and  Operations.     Edited  by  John  H.  Brinton,  M.  D.     Illustrated  with 

fhree  hundred  and  eleven  engravings  on  wood.     In  one  large  and  handsome  octavo  volume,  of 

over  nine  hundred  closely  printed  pages.     {Just  Issued.) 

It  is,  in  our  humble  judgment,  decidedly  tlie  best 
book  of  the  kind  in  the  English  language.  Strange 
that  just  such  books  are  notoftener  produced  by  pui> 
lie  teachers  of  surgery  in  this  country  and  Great 
Britain     Indeed,  it  is  a  matter  of  great  astonishment. 


but  no  les*  true  than  astonishing,  that  of  the  many 
works  on  surgery  republished  in  this  country  within 
i tie  jast  fifteen  or  twenty  years  as  text-books  for 
medical  siuiients,  this  is  the  only  one,  that  even  ap- 
proximates to  ihr  fulfilment  of  the  peculiar  wants  Ol 
young  men  just  entering  upon  the  study  of  thi*  branch 
of  ihe  profession. —  Western  Jour. of  Med.  and  Surgery. 

Embracing,  as  will  be  perceived,  the  whole  surgi- 
cal domarii,  and  each  division  of  itself  almost  com- 
plete and  perfect,  each  chapter  full  and  explicit,  each 
subject  faithfully  exhibited,  we  can  only  express  our 
exiimaie  ol  it  in  the  aggregate.  We  consider  it  an 
excellent  contribution  to  surgery,  as  probably  the 
lies!  single  volume  now  extant  on  ihe  subject,  and 
with  great  pleasure  we  add  it  10  our  text  books — 
Nashville.  Journal  of  Medicine  and  Surgery. 

lis  value  is  greatly  enhanced  by  a  very  copious 
well-arranged  index.  We  regard  this  as  one  of  the 
most  valuable  contributions  to  modern  surgery.  To 
one  entering  his  novitiate  of  practice,  we  regard  il 


the  most  serviceable  guide  which  he  can  consult.  He 
will  find  a  fulness  of  detail  leading  him  through  every 
step  of  the  operation,  and  not  deserting  him  until  the 
final  issue  of  the  case  is  decided.  For  the  same  rea- 
son we  recommend  it  to  those  whose  routine  of  prac- 
tice lies  in  such  parts  of  the  country  that  they  must 
rarely  encounter  cases  requiring  surgical  manage- 
ment.— Stethoscope. 

Prof.  Erichsen's  work,  for  its  size,  has  not  been 
surpassed;  his  nine  hundred  and  eight  pages,  pro- 
fusely illustrated,  are  rich  in  physiological,  patholo- 
gical, and  operative  suggestions,  doctrines,  details, 
and  processes;  and  will  prove  a  reliable  resource 
for  information,  boih  to  physician  and  surgeon,  in  trie 
hour  of  peril — iY.  0.  Med.  and  Surg  Journal. 

We  are  acquainted  with  nn  other  work  wherein 
so  much  good  sense,  sound  principle,  and  practical 
inferences,  stamp  every  page.  To  say  more  of  the 
volume  would  be  useless;  to  say  less  would  be  doing 
injustice  to  a  production  which  we  consider  above 
all  others  at  the  present  day,  and  superior  and  more 
complete  than  the  many  excellent  treatises  ot  the 
Knglish  and  Scotch  surgeons,  and  this  is  no  small 
encomium. — American  Lancet. 


ELLIS  (BENJAMIN),  M.D. 
THE    MEDICAL   FORMULARY :   being  a  Collection  of  Prescriptions,  derived 

from  Ihe  writings  and  praciice  of  many  of  the  most  eminent  physicians  of  America  and  Europe. 
Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  To  which  is  added 
an  Appendix,  on  the  Endermic  use  of  Medicines,  and  on  the  use  of  El  her  and  Chloroform.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Tenth  edition, 
revised  and  much  extended  by  Robert  P.  Thomas,  M.  D.,  Professor  of  Materia  Mcdica  in  the 
Philadelphia  College  of  Pharmacy.  In  one  neal  octavo  volume,  of  two  hundred  and  ninety-six 
pages.    (Lately  Issued.) 

After  an  examination  of  the  new  matter  and  the 
alterations,  we  believe  the  reputation  of  the  work 
built  up  by  the  author,  and  the  late  distinguished 
editor,  will  continue  to  flourish  under  the ao spices 
of  the  present  editor,  who  has  the  industry  and  accu- 
racy, and,  we  would  say,  conscientiousness  requi- 
site for  the  responsible  task. — American  Journal  of 
Pharmacy,  March,  1&J4. 


It  will  prove  particularly  useful  to  students  and 
young  practitioners,  as  the  most  important  prescrip- 
tions employed  in  modern  practice,  which  lie  scat- 
tered through  our  medical  literature,  are  here  col- 
lected and  conveniently  arranged  for  reference. — 
Charleston  Med.  Journal  and  Review. 


FOWNES  (GEORGE),   PH.  D.,  &.c. 
ELEMENTARY    CHEMISTRY;    Theoretical  and  Practical.     With  numerons 

illustrations.  A  new  American,  from  the  last  and  revised  London  edition.  Edited,  wilh  Addi- 
tions, by  Robert  Bridges,  M.  D.  In  one  large  royal  12mo.  volume,  of  over  550  pages,  wilh  181 
wood-cuts,  sheep,  or  extra  cloth.     (Now  Ready.) 

We  know  of  no  better  text-book,  especially  in  the  l  The  work  of  Dr.  Fownes  has  long  been  before 
difficult  department  of  organic  chemistry,  upon  the  public,  and  its  merits  have  been  fully  appreci- 
which  it  is  particularly  full  and  satisfactory.  We  ated  as  the  best  text-book  on  chemistry  now  in 
would  recommend  it  to  preceptors  as  a  capital  existence.  We  do  not.  of  course,  place  it  in  a  rank 
"  office  book"  for  their  students  who  are  beginners  superior  to  the  works  of  Erande,  Graham,  Turner, 
in  Chemistry.  It  is  copiously  illustrated  with  ex-  Gregory,  or  Gmelin,  but  we  say  that,  as  a  work 
cellent  wood-cuts,  and  altogether  admirably  "got  for  students,  it  is  preferable  to  any  of  them. — Lon.- 
up." — IV.  J.  Medical  Reporter,  March,  1S54.  don  Journal  of  Medicine. 


A  standard  manual,  which  has  long  enjoyed  the 
reputation  of  embodying  much  knowledge  in  a  .small 
space.  The  author  baB achieved  the  difficult  task  of 
condensation  with  masterly  tact.  His  book  is  con- 
cise without  being  dry,  and  brief  without  being  too 
dogmatical  or  general. —  Virginia  Med.  and  Surgical 
Journal. 


A  work  well  adapted  to  the  wants  of  the  student. 
It.  is  an  excellent  exposition  of  the  chief  doctrines 
and  factsof  modern  chemistry.  The  size  of  the  work, 
and  still  more  the  condensed  yet  perspicuous  style 
in  which  it  is  written,  absolve  it  from  the  charges 
very  properly  urged  against  most  manuals  termed 
popular. — Edinburgh  Monthly  Journal  of  Medical 
Science. 


FLINT  (AUSTIN),  M .  D., 

Professor  of  the  Theory  and  Practice  of  Medicine  in  the  University  of  Louisville,  &c. 

PHYSICAL  EXPLORATION  AND  DIAGNOSIS  OF  DISEASES  AFFECT- 
ING THE  ORGANS  OF  RESPIRATION.     In  one  handsome  octavo  volume.    (Now  Ready.) 

The  reputation  already  acquired  by  the  author  with  respect  to  his  researches  on  this  and  kindred 
topics,  is  sufficient  guarantee  that  he  will  accomplish  his  object  in  presenting  the  student  with  a 
good  practical  text-book,  which  will  facilitate  the  acquirement  of  a  knowledge  of  this  dilficult  sub- 
ject.    The  work  will  be  ready  in  time  for  the  Fall  sessions. 


AND    SCIENTIFIC    PUBLICATIONS. 


IS 


FERGUSSOM   (WILLIAM),  F.  R.  S., 

Professor  of  Surgery  in  King's  College,  London,  &c. 

A  SYSTEM  OF  PRACTICAL  SURGERY.     Fourth  American,  from  the  third 

and  enlarged  London  edition.     In  one  large  and  beautifully  printed  octavo  volume,  of  about  seven 

hundred  pages,  with  three  hundred  and  ninety-three  handsome  illustrations.     {Just  Issued.) 

The  most  important  subjects  in  connection  with  I      No  work  was  ever  written  which  more  nearly 

practical   surgery  which  have  been  more  recently    comprehended  the   necessities   of    the   student  and 

brought  under  the  notice  of,  and  discussed  by,  the  |  practitioner,  and  was   more   carefully  arranged   to 


surgeons  of  Great  Britain,  are  fully  and  dispassion 
ately  considered  by  Mr.  Fergusson,  and  that  which 
was  before  wanting  has  now  been  supplied,  so  that 
we  can  now  look  upon  itasa  work  on  practical  sur- 
gery instead  of  one  on  operative  surgery  alone. 
There  was  some  ground  formerly  for  the  complaint 
before  alluded  to,  that  it  dwelt  too  exclusively  on 
operative  surgery  ;  but  this  defect  is  now  removed, 
and  the  book  is  more  than  ever  adapted  for  the  pur- 
poses of  the  practitioner,  whether  he  confines  him- 
self more  strictly  to  the  operative  department,  or 
follows  surgery  on  a  more  comprehensive  scale. — 
Medical  Times  and  Gazette. 


that  single  purpose  than  this. — N.  Y.  Mud.  and  Surg. 
Journal. 

The  addition  of  many  new  pages  makes  this  work 
more  than  ever  indispensable  to  the  student  and  prac- 
titioner.— Ranking- s  Abstract. 

Among  the  numerous  works  upon  surgery  pub- 
lished of  late  years,  we  know  of  none  we  value 
more  highly  than  the  one  before  us.  It  is  perhaps 
the  very  best  we  have  for  a  text-book  and  for  ordi- 
nary reference,  being  concise  and  eminently  practi- 
cal.— Southern  Med.  and  Surg.  Journal. 


GRAHAM   (THOMAS),    F.  R.S., 

Professor  of  Chemistry  in  University  College,  London,  &c. 

THE  ELEMENTS  OF  CHEMISTRY.     Including  the  application  of  the  Science 

to  the  Arts.     With  numerous  illustrations.    With  Notes  and  Additions,  by  Robert  Bridges, 
M.  D.,  &c.  ecc.     Second  American,  from  the  second  and  enlarged  London  edition 

PART  I.  (Lately  Issued)  large  8vo.,  430  pages,  185  illustrations. 

PART  II.  {Preparing)  to  match. 

The  great  changes  which  the  science  of  chemistry  has  undergone  within  the  last  few  years,  ren- 
der a  new  edition  of  a  treatise  like  the  present,  almost  a  new  work.  The  author  has  devoted 
several  years  to  the  revision  of  his  treatise,  and  has  endeavored  to  embody  in  it  every  fact  and 
inference  of  importance  which  has  been  observed  and  recorded  by  the  great  body  of  chemical 
investigators  who  are  so  rapidly  changing  the  face  of  the  science.  In  this  manner  the  work  has 
been  greatly  increased  in  size,  and  the  number  of  illustrations  doubled  ;  while  the  labors  of  the  editor 
have  been  directed  towards  the  introduction  of  such  matters  as  have  escaped  the  attention  of  the 
author,  or  as  have  arisen  since  the  publication  of  the  first  portion  of  this  edition  in  London,  ml8.'")0. 
Printed  in  handsome  style,  and  at  a  very  low  price,  it  is  therefore  confidently  presented  to  the  pro- 
fession and  the  student  as  a  very  complete  and  thorough  text-book  of  this  important  subject. 


GRIFFITH  (ROBERT   E.),   M.  D.,  &c. 
A  UNIVERSAL  FORMULARY,  containing  the  methods  of  Preparing  and  Ad- 
ministering Officinal  and  other  Medicines.     The  whole  adapted  to  Physicians  and  Pharmaceu- 
tists.    Second  Edition,  thoroughly  revised,  with  numerous  additions,  by  Robert  P.  Thomas, 
M.  D.,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of  Pharmacy.     In  one  large  and 
handsome  octavo  volume,  of  over  six  hundred  pages,  double  columns.     (Just  Issued.) 
It  was  a  work  requiring  much  perseverance,  and  j      It  is  one  of  the  most  useful  books  a  country  practi- 
when  published  was  looked  upon  a<  by  far  the  best 
work  of  its  kind  lhat  had  issued  from  the  American 
press,  being  free  of  much  of  lhe  trashy,  and  embrac- 
ing most  of  the  non-officinal  formulae  used  or  known 
in  American,  English,  or  French  practice,  arranged 
under  the  heads  of'the  several  consiitueutdrugs.  plac- 
ing the  receipt  under  its  more  important  constituent. 
Prof  Thomas  has  certainly  "improved."  as  well  as 
added   o  this  Formulary,  and  has  rendered  it  addition- 
ally deserving  of  the  confidence   of  pharmaceutists 
and  physicians. — American  Journal  of  Pharmacy. 

We  are  happy  to  announce  a  new  and  improved 
edition  of  litis,  one  of  lhe  most  valuable  and  useful 
works  that  have  emanated  from  an  American  pen. 
It  would  do  credit  to  any  country,  and  will  be  found 
of  daily  usefulness  to  practitioners  of  medicine;  it  is 
belter  adapted  10  their  purposes  than  the  dispen?ato 
rie&.— Southern  Med.  and  Surg.  Journal. 

A  new  edition  of  this  well-known  work,  edited  by 
R.  P.  Thomas,  M  D.,  affords  occasion  for  renewing 
our  commendation  of  so  useful  a  handbook,  which 
ought  to  be  universally  studied  by  medical  men  of 
every  class,  ami  made  use  of  by  way  of  reference  by 
office  pupils,  as  a  standard  authority.  It  has  been 
much  enlarged,  and  now  condenses  a  vast  amount 
of  needful  and  necessary  knowledge  in  small  com- 
pass. The  more  of  such  books  the  better  for  the  pro- 
fession and  the  public—  N.  Y.  Med.  Gazette. 


lioner  can  possibly  have  in  his  possession. — Medical 
Chronicle. 

The  amount  of  u=efu  l.every-day  matter,  for  a  prac- 
ticing physician,  is  really  immense.—  Boston  Med. 
and  Surg.  Journal. 

Tbi=  is  a  work  of  six  hundred  and  fifty  one  pasres, 
embracing  all  on  the  subject  of  preparing  and  admi- 
nistering medicines  that  can  be  desired  by  the.  physi- 
cian and  pharmaceutist. —  Western  Lancet. 

In  short,  it  is  full  and  complete  work  of  the  kind, 
and  should  be  m  the  hands  of  every  physician  and 
apothecary.     O  ■  Med.  and  Surg.  Journal. 

We  predic  a  great  sale  for  this  work,  and  we  espe- 
cially recommend  it  to  all  medical  teachers. —  Rich- 
mond Stethoscope. 

This  edition  of  Dr  Griffith's  work  has  been  greatly 
improved  by  the  revision  and  ample  additions  of  Dr. 
Thomas,  ami  is  now.  we  believe,  one  of  the  most 
complete  works  of  it*  kind  in  any  language.  The 
additions  amount  to  about  seventy  pages,  and  no 
effort  has  been  spared  to  include  in  them  all  the  re- 
cent improvements  which  have  been  published  in 
medical  journals,  and  systematic,  treatises.  A  work 
of  this  kind  appears  io  us  indispensable  to  the  physi- 
cian, and  lh»reis  none  we  can  more  cordially  recom- 
mend.—  iV.  JT.  Journal  of  Medicine. 


BY   THE   SAME   AUTHOR. 


MEDICAL  BOTANY;  or,  a  Description  of  all  the  more  important  Plants  used 

in  Medicine,  and  of  their  Properties,  Uses,  and  Modes  of  Administration.     In  one  large  octavo 
volume,  of  704  pages,  handsomely  printed,  with  nearly  350  illustrations  on  wood. 


GREGORY  (WILLIAM),    F.  R.  S.  E., 

LETTERS    TO  A  CANDID    INQUIRER    ON    ANIMAL 

In  one  neat  volume,  royal  12mo.,  extra  cloth,     pp.  384. 


MAGNETISM. 


IG 


BLANCHARD    &    LEA'S    MEDICAL 


GROSS  (SAMUEL  D.),   M.  D., 

Professor  of  Surgery  in  the  University  of  Louisville,  &c. 

A  PRACTICAL    TREATISE   ON   THE    DISEASES,    INJURIES,  AND 

MALFORMATIONS  OF  THE  URINARY  BLADDER,  THE  PROSTATE  GLAND,  AND 
THE  URETHRA.  Second  Edition,  revised  and  much  enlarged,  with  one  hundred  and  eighty- 
tour  illustrations.  In  one  large  and  very  handsome  octavo  volume,  of  over  nine  hundred  pages. 
(JYow  Ready.) 

The  author  has  availed  himself  of  the  opportunity  afforded  by  a  call  for  a  new  edition  of  this 
work,  to  thoroughly  revise  and  render  it  in  every  respect  worthy,  so  far  as  in  his  power,  of  the  very 
flattering  reception  whicn  has  been  accorded  to  it  by  the  profession.  The  new  matter  thus  added 
amounts  to  almost  one-third  of  the  original  work,  while  the  number  of  illustrations  has  been  nearly 
doubled.  These  additions  pervade  every  portion  of  the  work,  which  thus  lias  rather  the  aspect  of 
a  new  treatise  than  a  new  edition.  In  its  present  improved  form,  therefore,  it  may  confidently  be 
presented  as  a  complete  and  reliable  storehouse  of  information  on  this  important  class  of  diseases, 
and  as  in  every  way  fitted  to  maintain  the  position  which  it  has  acquired  in  Europe  and  in  this 
country,  as  the  standard  of  authority  on  the  subjects  treated  of. 

On  the  appearance  of  the  first  edition  of  this  work,  I  away  this  reproach  ;  and  so  completely  has  the  task 
the  leading  English  medical  review  predicted  that  it  '  been  fulfilled,  that  we  venture  to  predict  for  Dr. 
would  have  a  "  permanent  place  in  the  literature  of  I  Gross's  treatise  a  permanent  place  in  the  literature 
surgery  worthy  to  rank  with  the  best  works  of  the  of  surgery,  worthy  to  rank  with  the  best  works  of 
present  age."  This  prediction  has  been  amply  ful-  the  present  age.  Not  merely  is  the  matter  good, 
filled.  Dr.  Gross's  treatise  has  been  found  to  sup-  but  the  getting  up  of  the  volume  is  most  creditable 
ply  completely  the  want  which  has  been  felt  ever  to  transatlantic  enterprise;  the  paper  and  print 
since  the  elevation  of  surgery  to  the  rank  of  science,  would  do  credit  to  a  first-rate  London  establishment ; 
of  a  good  practical  treatise  on  the  diseases  of  the  I  and  the  numerous  wood-cuts  which  illustrate  it,  de- 
bladder  and  its  accessory  organs.  Philos  iphical  in  monstrate  that  America  is  making  rapid  advances  in 
its  design,  methodical  in  its  arrangement,  ample  and  this  department  of  art.  We  have,  indeed,  unfeigned 
sound  in  its  practical  details,  it  may  in  truth  he  said  pleasure  in  congratulating  all  concerned  in  this  pub- 
to  leave  scarcely  anything  to  be  desired  on  so  im-  lication,  on  the  result  of  their  labours;  and  expe- 
portant  a  subject,  and  with  the  additions  and  modi-  rience  a  feeling  something  like  what  animates  a  long- 
fications  resulting  from  future  discoveries  and  im-  expectant  .husbandman, who,  oftentimes  disappointed 
provemtnts,  it  will  probably  remain  one  of  the  most  by  the  produce  of  a  favorite  field,  is  at  last  agree- 
valuuble  works  on  this  subject  so  long  as  the  science  ably  surprised  by  a  stately  crop  which  may  bear 
of  medicine  shall  exist. — Boston  Med.  and  Surg,  comparison  with  any  of  its  former  rivals.  The 
Journal,  June  7,  1855.  :  grounds  of  our  high  appreciation  of  the  work  will 

A  volume  replete  with  truths  and  principles  of  the  !  &e  obvious  as  we  proceed  ;  and  we  doubt  not  that 
utmost  value  in  the  investigation  of  these  diseases.—  i  the  Present  facilities  for  obtaining  American  books 

will  induce  many  of  our  readers  to  verify  our  re- 
commendation by  their  own  perusal  of  it. — British 
and  Foreign  Medico-C hirurgical  Review. 

Whoever  will  peruse  the  vast  amount  of  valuable 


American  Medical  Journal 

Dr.  Gross  has  brought  all  his  learning,  experi- 
ence, tact,  and  judgment  to  the  task,  and  has  pro- 
duced a  work  worthy  of  his  high  reputation.  We 
feel  perfectly  safe  in  recommending  it  to  our  read- 
ers us  a  monograph  unequalled  in  interest  and 
practical  value  by  any  other  on  the  subject  in  our 
language. — Western  Journal  of  Med.  and  Surg. 

It  has  remained  for  an  American  writer  to  wipe 


practical  information  it  contains,  and  which  we 
have  been  unable  even  to  notice,  will,  we  think, 
agree  with  us,  that  there  is  no  work  in  the  English 
language  which  can  make  any  just  pretensions  to 
be  its  equal. — N.  Y.  Journal  of  Medicine. 


BY  THE  SAME  AUTHOR.      (Just  Issued). 

A  PRACTICAL  TREATISE  ON  FOREIGN  BODIES  IN  THE  AIR-PAS- 

SAGES.     In  one  handsome  octavo  volume,  with  illustrations,     pp.  468. 

A  very  elaborate  work.  It  is  a  complete  summary    a  most  interesting  and  hitherto  a  most  neglected  de- 
of  the  whole  subject,  and  will  be  a  useful  book  of    partment  of  surgical   pathology  and  practice. — St. 
reference. — British   and   Foreign   Medico-Chirurg.     Louis  Med.  and  Surg.  Journal,  May,  11555. 
Keview.  Surgical  authors,  isolated  reports  in  medical  pe- 

A  highly  valuable  book  of  reference  on  a  most  im-  riodicals  and  modern  surgeons  '  blend  their  common 
portant  subject  in  the  practice  of  medicine.  We  '  toil"  to  make  a  book  which  exhausts  the  subject, 
conclude  by  recommending  it  to  our  readers,  fully  and  must  forever  remain  the  standard  work  on  the 
persuaded  that  its  perusal  will  afford  them  much  management  of  this  accident. — Buffalo  Med.  J ourn. 
practical  information  well  conveyed,  evidently  de-  |      We  consider  tnis  work  one  of  the  most  important 


of  the  recent  additions  to  practical  surgery.  Con- 
taining all  that  has  been  recorded  relating  to  the 
class  of  accidents  of  which  it  treats,  admirably 
arranged  and  systematized,  it  should  find  a  place  in 


rived  from  considerable  experience  and  deduced  from 
an  ample  collection  of  facts.  —  Dublin  Quarterly 
Journal,  May,  1855. 

In  this  valuable  monograph  Dr.  Gross  has  cer- 
tainly struck  a  new  lead  in  Surgery,  and  is  entitled     everyinedical  library. — Montreal  Med.  Chronicle. 
to  the  credit  of  having  illustrated  and  systematized  I 

by  the  same  author.     (Preparing.) 

A  SYSTEM  OF  SURGERY;  Diagnostic,  Pathological,  Therapeutic,  and  Opera- 

tive.     With  very  numerous  engravings  on  wood. 

BY   THE    SAME   AUTHOR. 

ELEMENTS  OF  PATHOLOGICAL  ANATOMY;  illustrated  by  colored  En- 

gravings,  and  two  hundred  and  fifty  wood-cuts.     Second  edition,  thoroughly  revised  and  greatly 

enlarged.     In  one  very  large  and  handsome  imperial  octavo  volume,  pp.  822. 

We  recommend  it  as  the  most  complete,  and,  on    The  colored  engravings  and  wood-cuts  are  exceed- 


the  whole,  the  least  defective  compilation  on  the 
subject  in  the  English  language. — Brit,  and  For. 
Med.  Journal. 

It  is  altogether  the  most  complete  exposition  of 
Pathological  Anatomy  in  our  language. — American 
Journal  of  Medical  Sciences. 

if.  is  the  most  complete  and  useful  systematic  work 
on  Kthological  Anatomy  in  the  English  language. 


ingly  well  executed,  and  the  entire  getting  up  of  the 
work  does  much  credit  to  the  enterprising  publishers. 
We  regard  it  as  one  of  the  most  valuable  works 
ever  issued  from  the  American  press,  and  it  does 
great  honor  alike  to  the  author,  and  the  country  of 
his  birth. — N.  Y.  Journal  of  Medicine. 

We  commend  it  to  the  attention  of  the  profession 
as  one  of  the  best  extant  upon  the  subject  on  which 
it  treats. — Southern  Journal  Med.  and  Pharmacy. 


AND    SCIENTIFIC    PUBLICATIONS.  17 

GLUGE  (GOTTLIEB),   M.  D., 

Professor  of  Physiology  and  Pathological  Anatomy  in  the  University  of  Brussels,  &c. 

AN  ATLAS   OF   PATHOLOGICAL   HISTOLOGY.     Translated,  with  Notes 

and  Additions,  by  Joseph  Leidy,  M.  D.,  Professor  of  Anatomy  in  the  University  of  Pennsylva- 
nia. In  one  volume,  very  large  imperial  quarto,  with  three  hundred  and  twenty  figures,  plain 
and  colored,  on  twelve  copperplates. 

This  being,  as  far  as  we  know,  the  only  work  in  the  unconnected  observations  of  a  great  number  of 
which  pathological  histology  is  separately  treated  authors.  The  development  of  the  morbid  tissues, 
of  in  a  comprehensive  manner,  it  will,  we  think,  for  and  the  formation  of  abnormal  products,  raav  now 
this  reason,  be  of  infinite  service  to  those  who  desire  be  followed  and  studied  witli  the  same  ease  and 
to  investigate  the  subject  systematically,  and  who  satisfaction  as  the  best  arranged  Bystem  of  phy- 
have  felt  the  difficulty  of  arranging  in   their  mind     siology.— American  Med.  Journal. 


GARDNER  (D.  PEREIRA),  M .  D. 
MEDICAL  CHEMISTRY,  for  the  use  of  Students  and  the  Profession:  being  a 

Manual  oi  the  Science,  with  its  Applications  to  Toxicology,  Physiology,  Therapeutics,  Hygiene, 
&c.     In  one  handsome  royal  12mo.  volume,  of  about  400  pages,  with  illustrations. 

HASSE  (C.  E.),   M.  D. 
AN  ANATOMICAL  DESCRIPTION  OF  THE  DISEASES  OF  RESPIRA- 
TION AND  CIRCULATION.     Translated  and  Edited  by  Swaine.    In  one  volume,  octavo. 

HARRISON  (JOHN),   M .  D. 
AN   ESSAY  TOWARDS  A   CORRECT  THEORY  OF  THE  NERVOUS 

SYSTEM.     In  one  octavo  volume,  292  pages. 


HUNTER  (JOHN). 
TREATISE  ON  THE  VENEREAL  DISEASE.     With  copious  Additions,  by 

Dr.  Ph.  Ricord,  Surgeon  to  the  Venereal  Hospital  of  Paris.     Edited,  with  additional  Notes,  by 
F.  J.  Bumstead,  M.  D.     In  one  octavo  volume,  with  plates     (Now  Ready.)     1^°  See  Ricord. 
Also,  HUNTER'S  COMPLETE  WORKS,  with  Memoir,  Notes,  &c.  &c.     In  four  neat  octavo 
volumes,  with  plates. 

HUGHES    (H.    M.),  M .  D., 
Assistant  Physician  to  Guy's  Hospital,  &c. 

A  CLINICAL  INTRODUCTION   TO  THE   PRACTICE   OF  AUSCULTA- 

TION,  and  other  Modes  of  Physical  Diagnosis,  in  Diseases  of  the  Lungs  and  Heart.     Second 
American  from  the  Second  and  Improved  London  Edition.  In  one  royal  12mo.  vol.  pp.  304. 

HORNER  (WILLIAM  E.),  M.  D., 

Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

SPECIAL   ANATOMY    AND    HISTOLOGY.     Eighth  edition.     Extensively 

revised  and  modified.     In  two  large  octavo  volumes,  of  more  than  one  thousand  pages,  hand- 
somely printed,  with  over  three  hundred  illustrations. 

This  work  has  enjoyed  a  thorough  and  laborious  revision  on  the  part  of  the  author,  with  the 
view  of  bringing  it  fully  up  to  the  existing  state  of  knowledge  on  the  subject  of  general  and  special 
anatomy.  To  adapt  it  more  perfectly  to  the  wants-of  the  student,  he  has  introduced  a  large  number 
of  additional  wood-engravings,  illustrative  of  the  objects  described,  while  the  publishers  have  en- 
deavored to  render  the  mechanical  execution  of  the  work  worthy  of  the  extended  reputation  which 
it  has  acquired.  The  demand  which  has  carried  it  to  an  EIGHTH  EDITION  is  a  sufficient  evi- 
dence of  the  value  of  the  work,  and  oi  its  adaptation  to  the  wants  oi  the  student  and  professional 
reader. 

HOBLYN  (RICHARD  D.),  A.  M . 
A  DICTIONARY  OF  THE  TERMS  USED  IN  MEDICINE  AND  THE 

COLLATERAL   SCIENCES.     New  and  much  improved  American  Edition.     Revised,  with 
numerous  Additions,  from  the  last  London  edition,  by  Isaac  Hays,  M.  D.,  &c.     In  one  large 
royal  12mo.  volume,  of  over  five  hundred  pages,  double  columns.     (Now  Ready.) 
In  passing  this  work  a  second  time  through  the  press,  the  editor  has  subjected  it  to  a  very  tho- 
rough revision,  making  such  additions  as  the  progress  of  science  has  rendered  desirable,  and  sup- 
plying any  omissions  that  may  have  previously  existed.     The  extent  of  these  addilions  may  be 
estimated  from  the  fact  that  this  edition  contains  about  one-third  more  mailer  than  the  previous 
one,  notwithstanding  which  it  has  been  kept  at  the  former  very  moderate  rate.     As  a  concise  and 
convenient  Dictionary  of  Medical  Terms,  at  an  exceedingly  low  price,  it  will  therefore  be  found  of 
great  value  to  the  student  and  practitioner. 

JONES  (T.   WHARTON),   F.  R.  S.,  &c. 
THE  PRINCIPLES  AND  PRACTICE  OF   OPHTHALMIC    MEDICLNE 

AND  SURGERY.    Edited  by  Isaac  Hays,  M.  D.,  &c.     In  one  very  neat  volume,  large  royal 
12mo.,  of  529  pages,  with  four  plates,  plain  or  colored,  and  ninety-eight  wood-cuis. 


The  work  amply  sustains,  in  every  point  the  al- 
ready high  reputation  of  the  author  as  an  ophthalmic 
surgeon  as  well  as  a  physiologist  and  pathologist. 
The  book  is  evidently  the  result  of  much  labor  and 
research,  and  has  been  written  with  the  greatest 
care  and  attention.  We  entertain  little  doubt  that 
this  book  will  become  what  its  author  hoped  it 


might  become,  a  manual  for  daily  reference  and 
consultation  by  the  student  and  t lie  general  practi- 
tioner. The  work  is  marked  by  that  correctness, 
clearness,  and  precision  of  style  which  distinguish 
all  the  productions  of  the  learned  author. — British 
and  Foreign  Medical  Review. 


BLANCHARD    &    LEA'S    MEDICAL 


JONES  (C.   HANDFIELD),  F.  R.  S.,  &,   EDWARD   H.   SIEVEKING,   M.D., 

Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital,  London. 

A  MANUAL  OF  PATHOLOGICAL   ANATOMY.     First  American  Edition, 

Revised.  With  three  hundred  and  ninety-seven  handsome  wood  engravings.  In  one  large  and 
beautiful  octavo  volume  of  nearly  seven  hundred  and  fifty  pages.  (Just  Issued.) 
In  a  work  like  the  present,  intended  as  a  text-book  for  the  student  of  pathology,  accurate  engrav- 
ings of  the  various  results  of  morbid  action  are  of  the  greatest  assistance.  The  American  pub- 
lishers have,  therefore,  considered  that  the  value  of  the  work  might  be  enhanced  by  increasing  the 
number  of  illustrations,  and,  with  this  object,  many  wood-cuts,  from  the  best  authorities,  have  been 
introduced,  increasing  the  number  from  one  hundred  and  sixty-seven,  in  the  London  Edition,  to 
three  hundred  and  ninety-seven  in  this.  The  selection  of  these  wood-cuts  has  been  made  by  a 
competent  member  of  the  profession,  who  has  supervised  the  progress  of  the  work  through  the 
press,  with  the  view  of  securing  an  accurate  reprint,  and  of  correcting  such  errors  as  had  escaped 
the  attention  of  the  authors. 

With  these  improvements,  the  volume  is  therefore  presented  in  the  hope  of  supplying  the  ac- 
knowledged want  of  a  work  which,  within  a  moderate  compass,  should  embody  a  condensed  and 
accurate  digest  of  the  present  state  of  pathological  science,  as  extended  by  recent  microscopical, 
chemical,  and  physiological  researches. 

Asa  concise  text-book,  containing,  in  a  condensed  authors  have  not  attempted  to  intrude  new  views  on 
form,  a  complete  outline  of  what  is  known  in  the  their  professional  brethren,  but  simply  to  lay  before 
domain  of  Pathological  Anatomy,  it  is  perhaps  the  them,  what  has  long  been  wanted,  an  outline  of  the 
beat  work  in  the  English  language.  Its  great  merit  present  condition  of  pathological  anatomy.  In  this 
consists  in  its  completeness  and  brevity,  and  in  this  they  have  been  completely  successful.  The  work  is 
respect  it  supplies  a  great  desideratum  in  our  lite-  one  of  the  best  compilations  which  we  have  ever 
rat u re.  Heretofore  the  student  of  pathology  was  '  perused.  The  opinions  and  discoveries  of  all  the 
obliged  to  glean  from  a  great  number  of  monographs,  leading  pathologists  and  physiologists  are  engrossed, 
and  the  field  was  so  extensive  that  but  few  cultivated  bo  that  by  reading  any  subject  treated  in  the  book 
it  with  sny  degree  of  success.  The  authors  of  the  you  have  a  synopsis  of  the  views  of  the  most  ap- 
present  work  have  sought  to  corrrct  this  defect  by  proved  authors. — Charleston  Medical  Journal  and 
placing  before  the  reader  a  summary  of  ascertained     Review. 

B^hilSK!llh^irfAe^lTiwtte^^?Jf,,,^",,t        we   have   no  hesitation  in   recommending   it 
pathologists  both  ot  the  Old  and  New  \\  odd. 

simple  work  of  reference,  therefore,  it  is 

value   to  the  student  of  pathological  anato 

should   be   in    every  physician's  library.—  Western 


i  eminent  vve   ]mve   nn   hesitation  in   recommending    it  as 

Id.     As  a  worthy  of  careful  and  thorough  study  by  every  mem- 

of  great  i,er  ))f  (ne  pr<)feSsion,  old,  or  young. — iV.  W.  Med. 

omy,  and  and  Sur?   Joltrnai. 


Lancet, 

We  urge  upon  our  readers  and  the  profession  gene- 
rally the  importance  of  informing  themselves  in  re- 
gard to  modern  views  of  pathology,  and  recommend 
to  tiiem  to  procure  the  work  before  us  as  the  best 
means  of  obtaining  this  information.— Stethoscope. 


From  the  casual  examination  we  have  given  we 
are  inclined  to  regard  it  as  a  text-book,  plain,  ra- 
tional, and  intelligible,  such  a  book  as  the  practical 
man  needs  for  daily  reference.  For  this  reason  it 
will  be  likely  to  be  largely  useful,  as  it  suits  itself 
to  those  busy  men  who  have  little  time  for  minute 
investigation,  and  prefer  a  summary  to  an  elaborate 


in  offering  the  above  titled  work  to  the  public,  the    treatise. — Buffalo  Medical  Journal. 


KIRKES  (WILLIAM   SENHOUSE),    M .  D., 

Demonstrator  of  Morbid  Anatomy  at  St.  Bartholomew's  Hospital,  &c.j  and 

JAMES   PAGET,   F.  R.  S., 

Lecturer  on  General  Anatomy  and  Physiology  in  St.  Bartholomew's  Hospital. 

A    MANUAL    OF    PHYSIOLOGY.     Second  American,  from  the  second  and 

improved  London  edition.    With  one  hundred  and  sixty-five  illustrations.     In  one  large  and 
handsome  royal  12oio.  volume,     pp.  5-">0.     (Just  Issued.) 

In  the  present  edition,  the  Manual  of  Physiology  i  the  practitioner  who  has  but  leisure  to  refresh  his 
has  been  brought  up  to  the  actual  condition  of  the  l  memory,  this  book  is  invaluable,  as  it  contains  all 
science,  and  fully  sustains  the  reputation  which  it  that  it  is  important  to  know,  without  special  details, 
has  already  so  deservedly  attained.  We  consider  which  are  read  with  interest  only  by  those  who 
the  work  of  MM.  Kirkes  and  Paget  to  constitute  one  I  would  make  a  specialty,  or  desire  to  possessa  criti- 
of  the  very  best  handbooks  of  Physiology  we  possess  ',  cal  knowledge  of  the  subject. — Charleston  Medical 
— presenting  just  such  an  outline  of  thescienee,  coin-  |  Journal. 

prising  an  account  of  its  leading  facts  and  generally  \      0ne  of  the  best  treatises  that  can  be  put  into  the 
admitted  principles,  as  the  student  requires  during    hands  of  the  student.— London  Medical  Gazette. 
his  attendance  upon  a  course  of  lectures,  or  for  re-  | 

Particularly  adapted  to  those  who  desire  to  pos- 
sess a  concise"  digest  of  the  facts  of  Human  Physi- 
ology.— British  and  Foreign  Med.-Chirurg.  Review. 
We  conscientiously  recommend  it  as  an  admira- 
ble "  Handbook  of  Physiology."— London  Journal 
of  Medicine. 


lor  examination. —  Am. 


ference  whilst  preparing 
Medical  Journal . 

We  need  only  say,  that,  without  entering  into  dis- 
cussions of  unsettled  questions,  it  contains  all  the 
recent  improvements  in  this  department  of  medical 
science.     For  the  student  beginning  this  study,  and 


KNAPP  (F.),  PH.  D.,  &.c. 
TECHNOLOGY;  or,  Chemistry  applied  to  the  Arts  and  to  Manufactures.  Edited, 
with  numerous  Notes  and  Additions,  by  Dr.  Edmund  Ronalds  and  Dr.  Thomas  Richardson. 
First  American  edition,  with  Notes  and  Additions,  by  Prof.  Walter  R.  Johnson.  In  two  hand- 
some octavo  volumes,  printed  and  illustrated  in  the  highest  style  of  art,  with  about  five  hundred 
wood-engraving's. 


LONGET  (F.  A.) 
TREATISE    ON    PHYSIOLOGY.     With  numerous  Illustrations.     Translated 

from  the  French  by  F.  G.  Smith,  M.  D.,  Professor  of  Institutes  of  Medicine  in  the  Pennsylvania 
(Preparing.) 


Medical  Colles 


LALLEMAND  (M.). 
THE    CAUSES,    SYMPTOMS,    AND    TREATMENT    OF    SPERMATOR- 

RHCEA.     Translated  and  edited  bv  Henry  J.  McDougal.    In  one  volume,  octavo,  320  pages. 


AND    SCIENTIFIC    PUBLICATIONS.  19 

LEHMANN    (G.   C.) 
PHYSIOLOGICAL    CHEMISTRY.     Translated  by  George  E.  Day,  M.  D., 

and  edited  by  Prof.  R.  E.  Rogers,  of  the  University  of  Pennsylvania.    In  two  large  octavo 

volumes,  with  nearly  two  hundred  illustrations.     (Now  Ready.) 

This  great  work,  universally  recognized  as  the  most  complete  and  authoritative  exposition  of  ita 
intricate  and  important  subject  in  its  most  advanced  condition,  has  received  every  care  during-  n* 
passage  through  the  press,  under  the  superintendence  of  Prof.  Rogers,  to  insure  the  entire  accuracy 
indispensable  to  a  work  of  this  character.  It  has  also  been  improved  by  the  distribution  in  the 
appropriate  places  throughout  the  text  of  the  numerous  additions  and  corrections  embodied  in  the 
Appendix,  while  a  number  of  illustrations  have  been  introduced  from  "Funke's  Atlas  of  Physiological 
Chemistry,"  and  an  Appendix  of  Plates  has  been  added.  The  publishers,  therefore,  trust  that  it 
will  he  found  a  complete  and  accurate  edition,  and  in  every  respect  worthy  of  the  reputation  of  the 
work. 

The  progress  of  research  in  this  department  is  so  and  exact  view  of  its  present  aspect,  should  lose  no 
rapid,  that  Prof.  Lehmann's  treatise  must  he  re-  time  in  attaching  themselves  to  the  Society  by  which 
garded  as  having  completely  superseded  that  of  it  is  in  course  of  publication. — British  and  Foreign 
Simon;  and  all  who  desire  to  possess  a  systematic  ,  Medico-Chirurgical  Review. 

work  on  Physiological  Chemistry  by  a  man  who  is  T]]e  work  of  Lehmann  stands  unrivalled  as  the 
thoroughly  qualified,  both  by  his  physiological  and  most  comprehensive  book  of  reference  and  informa- 
Chemical  acquirements,  by  his  own  eminence  as  an  tion  ext;lnt  „„  ny  br.inch  of  ll|t,  Bubject  ,,„  which 
experimentalist,  and  by  the  philosophic  impartiality  it  treats  — 2Jrfia6«rg-  Monthly  Journal  of  Medical 
of  his  habits  of  thought,  to  afford  a  comprehensive    Science. 

by  the  same  author.     (Now  Ready.) 

CHEMICAL   PHYSIOLOGY.      Translated,   with   numerous   additions,   by   J. 

Cheston  Morris,  M.  D.,  with  an  Introduction  by  Prof.  S.  Jackson,  of  the  University  of  Penn- 
sylvania,    la  one  handsome  octavo  volume,  with  illustrations. 

The  original  of  this  work,  though  but  lately  issued  by  its  distinguished  author,  has  already 
assumed  the  highest  position,  as  presenting  in  their  latest  development  the  modern  doctrines  and 
discoveries  in  the  chemistry  of  life.  The  numerous  additions  by  the  translator,  and  the  Introduc- 
tion by  Professor  Jackson  will  render  its  physiological  aspect  more  complete  than  designed  by  the 
author,  and  will  adapt  it  for  use  as  a  text-book  of  physiology,  presenting  more  thoroughly  than  has 
yet  been  attempled,  the  modifications  arising  from  the  vast  impulse  which  organic  chemistry  has 
received  within  a  few  years  past. 

LAWRENCE  (W.),   F.  R.  S.,  Sic. 
A  TREATISE    ON    DISEASES    OF    THE    EYE.     A    new  edition,   edited, 

with  numerous  additions,  and  243  illustrations,  by  Isaac  Hays,  M.  D.,  Surgeon  to  Wills  Hospi- 
tal, &c.  In  one  very  large  and  handsome  octavo  volume,  of'950  pages,  strongly  bound  in  leather 
with  raised  bands.     (Lately  Issued.) 

This  work  is  so  universally  recognized  as  the  standard  authority  on  the  subject,  that  the  pub- 
lishers in  presenting  this  new  edition  have  only  to  remark  that  in  its  preparation  the  editor  has 
carefully  revised  every  portion,  introducing  additions  and  illustrations  wherever  the  advance  of 
science  has  rendered  them  necessary  or  desirable.  The  various  important  contributions  to 
ophthalmological  science,  recently  made  by  Dalrymple,  Jacob,  Walton,  Wilde,  Cooper,  &c, 
both  in  the  form  of  separate  treatises  and  contributions  to  periodicals,  have  been  carefully 
examined  by  the  editor,  and,  combined  with  the  results  of  his  own  experience,  have  been 
freely  introduced  throughout  the  volume,  rendering  it  a  complete  and  thorough  exponent  of 
the  most  advanced  state  of  the  subject. 

This  admirable  treatise- the  safest  guide  and  most  ]  octavo  pages- has  enabled  both  author  and  editor  to 
comprehensive  work  of  reference,  which  is  within  j  do  justice  to  all  the  details  of  this  subject,  and  o  n- 
the  reach  of  the  profession. — Stethoscope.  dense  in  this  single  volume  the  present  state  of  oar 


This  standard  text-book  on  the  department  of 
whieh  it  treats,  has  not  been  superseded,  by  any  or 
all  of  the  numerous  publications  on  the  subject 
heretofore  issued.  Nor  with  the  multiplied  improve- 
ments of  Dr.  Hays,  the  American  editor,  is  it  at  all 
likely  that  this  great  work  will  cease  to  merit  the 
confidence  and  preference  of  students  or  practition- 


knowledge  of  the  whole  science  in  tltis  department, 
whereby  its  practical  value  cannot  he  excelled.  We 
heartily  commend  it,  especially  as  a  book  of  refe- 
rence, indispensable  in  every  medical  library.  The 
additions  of  the  American  editor  very  greatly  en- 
hance the  value  of  the  work,  exhibiting  the  learning 
and  experience  of  Dr.  Hays,  in  the  light  in  whieh  he 
ousht  to  be  held,  as  a  standard  authority  on  all  sab- 

-         .       . .._  :_;_'     ...  .u: ....;.  .It.-  M    V     ATtA     C±n~ 


ers.     Its  ample  extent — nearly  one  thousand  large;  jects  appertaining  to  this  specialty.—  A.  Y.  Med.  Gaz. 

LEE  (ROBERT),   M.  D.,  F.  R.  S.,  &c. 
CLINICAL    MIDWIFERY;    comprising  the   Histories  of  Five  Huudred  and 

Forty-five  Cases  of  Difficult,  Preternatural,  and  Complicated  Labor,  with  Commentaries.    From 
an  edition.     In  one  royal  12mo.  volume,  extra  cloth,  of  238  pages. 


the  second  London  edition.     In  one  royi 


LUDLOW    (J.    L.),    M.  D., 

Lecturer  on  Clinical  Medicine  at  the  Philadelphia  Almshouse,  &c. 

A  MANUAL  OF  EXAMINATIONS  upon  Anatomy  and  Physiology,  Surgery, 

Practice  of  Medicine,  Chemistry,  Obstetrics,  Materia  Medica,  Pharmacy,  and  Therapeutics. 
Designed  for  Students  of  Medicine  throughout  the  United  States.  A  new  edition,  revised  and 
improved.     In  one  large  royal  12mo.  volume,  with  several  hundred  illustrations.     (Preparing.) 

LISTON  (ROBERT),   F.  R.  S.,  &c. 
LECTURES  ON  THE  OPERATIONS  OF  SURGERY,  and  on  Diseases  and 

Accidents  requiring  Operations.  Edited,  with  numerous  Additions  and  Alterations,  by  T.  D. 
Mutter,  M.  D.     In  one  large  and  handsome  octavo  volume,  of  506  pages,  with  216  wood-cuts. 


20 


BLANCHARD    &    LEA'S    MEDICAL 


LA   ROCHE   (R.),    M .  D.,  &c. 
PNEUMONIA ;  its  Supposed  Connection,  Pathological  and  Etiological,  with  Au- 
tumnal Fevers,  including  an  Inquiry  into  the  Existence  and  Morbid  Agency  of  Malaria.     In  one 
handsome  octavo  volume,  extra  cloth,  of  500  pages. 

A  more  simple,  clear,  and  forcible  exposition  of  I  This  work  should  be  carefully  studied  by  Southern 
the  groundless  nature  and  dangerous  tendency  of  |  physicians,  embodying  as  it  does  the  reflections  of 
certain  pathological  and  etiological  heresies,  has  I  an  original  thinker  and  close  observer  on  a  subject 
seldom  been  presented  to  our  notice. — N.  Y.  Journal  peculiarly  their  own. — Virginia  Med.  and  Surgical 
0/ Medicine  and  Collateral  Science.  j  Journal. 

by  the  same  author.     (Now  Ready.) 

YELLOW  FEVER,,  considered  in  its  Historical,  Pathological,  Etiological,  and 

Therapeutical  Relations.  Including  a  Sketch  of  the  Disease  as  it  has  occurred  in  Philadelphia 
from  1699  to  1854,  with  an  examination  of  the  connections  between  it  and  the  fevers  known  under 
the  same  name  in  other  parts  of  temperate  as  well  as  in  tropical  regions.  In  two  large  and 
handsome  octavo  volumes  of  nearly  1500  pages. 

The  publishers  are  happy  in  being  able  at  length  to  present  to  the  profession  this  great  work, 
which  they  are  assured  will  be  regarded  as  an  honor  to  the  medical  literature  of  the  country.  As 
the  result  of  many  years  of  personal  observation  and  study,  as  embodying  an  intelligent  resume  of 
all  that  has  been  written  regarding  the  disease,  and  as  exhausting  1he  subject  in  all  its  various 
aspects,  these  volumes  must  at  once  take  the  position  of  the  standard  authority  and  work  of  refe- 
rence on  the  many  important  questions  brought  into  consideration. 

curate  and  thorough  knowledge  of  the  subject,  ac- 
quired by  ample  experience  and  opportunities  for 
investigations  both  at  home  and  abroad,  while  he 
brings  to  his  task  peculiar  qualifications  by  his  pro- 
found learning  in  all  that  appertains  to  the  science 
and  art  of  healing.  AVe  recommend  it  to  the  pro- 
fesaioo  and  the  public  as  an  able  and  elaborate  ri- 
l  ,,  "I  all  that  is  known  on  the  subject  of  Yellow 
Fever,  with  a  vast  amount  of  information  upon 
every  aspect  of  this  important  topic,  upon  which 
the  author  has  expended  an  amount  of  industry  and 
renins  which  can  never  be  adequately  rewarded, 
however  appreciated  by  his  brethren. — N.  Y.  Medi- 
cal Gazette,  October,  1655. 


From  Professor  S.  J{.  Dickson.  Charlestcn,  S.  C, 
September  18,  1855. 
A  monument  of  intelligent  and  well  applied  re- 
search, almost  without  example.  It  is,  indeed,  in 
itself,  a  large  library,  and  is  destined  to  constitute 
the  special  resort  as  a  book  of  reference,  in  the 
subject  of  which  it  treats,  to  all  future  time. 

This  truly  great  work  has  just  appeared  in  two 
large  octavo  volumes,  and  while  it  will  be  hailed 
throughout  our  country  as  a  must  timely  and  desira- 
ble contribution  to  American  Medical  Literature,  it, 
will  be  sought  for  and  read  with  avidity  abroad,  for 
its  author  has  a  world-wide  reputation  in  scholastic 
and  practical  medicine.     Dr.  La  Roche  has  an  ac- 


LARDNER  (DIONYSIUS),  D.  C.  L.,  &.c. 
HANDBOOKS    OF    NATURAL    PHILOSOPHY    AND 


ASTRONOMY. 


Revised,  with  numerous  Additions,  by  the  American  editor.  First  Course,  containing  Mecha- 
nics, Hydrostatics,  Hydraulics,  Pneumatics,  Sound,  and  Optics.  In  one  large  royal  12mo. 
volume,  of  750  pages,  with  -124  wood-cuts.  Second  Course,  containing  Heat,  Electricity,  Mag- 
netism,  and  Galvanism,  one  volume,  large  royal  12mo.,  of  450  pages,  with  250  illustrations. 
Third  Course  (  now  ready), containing  Meteorology  and  Astronomy,  in  one  large  volume,  royal 
12mo.  of  nearly  eight  hundred  pages,  with  thirty-seven  plates  and  two  hundred  wood-cuts.  The 
whole  complete  in  three  volumes,  of  about  two  thousand  large  pages,  with  over  one  thousand 
figures  on  steel  and  wood.  Any  volume  sold  separate. 
The  various  sciences  treated  in  this  work  will  be  found  brought  thoroughly  up  to  the  latest  period. 


MACKENZIE   (W.),    M.D., 
Surgeon  Oculist  in  Scotland  in  ordinary  to  Her  Majesty,  &C.&C. 

A  PRACTICAL   TREATISE  ON   DISEASES    AND  INJURIES  OF   THE 

EYE.  To  which  is  prefixed  an  Anatomical  Introduction  explanatory  of  a  Horizontal  Section  of 
the  Human  Eyeball,  by  Thomas  Wharton  Jones,  F.  R.  S.  From  the  Fourth  Revised  and  En- 
larged London  Edition.  With  Notes  and  Additions  by  Addinell  Hewson,  M.D.,  Surgeon  to 
Wills  Hospital,  &c.  ccc.  In  one  very  large  and  handsome  octavo  volume,  with  plates  and  numerous 
wood-cuts.     (Now  Ready.) 

The  treatise  of  Dr.  Mackenzie  indisputably  holds  1  accordance  with  the  advances  in  the  science  which 
the  first  place,  and  forms,  in  respect  of  learning  and    have  been  made  of  late  years.    Nothing  worthy  of 

repetition  upon  any  branch  of  the  subject  appears  to 
have  escaped  the  author's  notice.  We  consider  it 
the  duty  of  every  one  who  has  the  love  of  his  profes- 
sion and  the  welfare  of  his  patient  at  heart,  to  make 
himself  familiar  with  this  the  most  complete  work 
in  the  English  language  upon  the  diseases  of  the  eye. 
— Med.  Times  and  Gazette. 

The  fourth  edition  of  this  standard  work  will  no 
doubt  be  as  fully  appreciated  as  the  three  former  edi- 
tions. It  is  unnecessary  to  say  aword  in  its  praise, 
for  the  verdict  has  already  been  passed  upon  it  by 
the  most  competent  judges,  and  "  Mackenzie  on  the 
Eye"  has  justly  obtained  a  reputation  which  it  is 
no  figure  of  speech  to  call  world-wide. — British  and 
Foreign  Medico-C 'hirurgical  Review. 

This  new  edition  of  Dr.  Mackenzie's  celebrated 
treatise  on  diseases  of  the  eye,  is  truly  a  miracle  of 
industry  and  learning.  We  need  scarcely  say  that 
he  has  entirely  exhausted  the  subject  of  his  specialty. 
— Dublin  Quarterly  Journal. 


research,  an  Encyclopaedia  unequalled  in  extent  by 
any  other  work  of  the  kind,  either  English  or  foreign. 
— Dixon  on  Diseases  of  the  Eye. 

Few  modern  books  on  any  department  of  medicine 
or  surgery  have  met  with  such  extended  circulation, 
or  have  procured  for  their  authors  a  like  amount  of 
European  celebrity.  The  immense  research  which 
it  displayed,  the  thorough  acquaintance  with  the 
subject,  practically  as  well  as  theoretically .  and  the 
able  manner  in  which  the  author's  stores  of  learning 
and  experience  were  rendered  available  for  general 
use,  at  once  procured  for  the  first  edition,  as  well  on 
the  continent  as  in  this  country,  that  high  position 
as  a  standard  work  which  each  successive  edition 
has  more  firmly  established,  in  spite  of  the  attrac- 
tions of  several  rivals  of  no  mean  ability.  This,  the 
fourth  edition,  has  been  in  a  great  measure  re-writ- 
ten ;  new  matter,  to  the  extent  of  one  hundred  and 
fifty  pages,  has  been  added,  and  in  several  instances 
formerly  expressed  opinions  have  been  modified  in 


AND    SCIENTIFIC    PUBLICATIONS. 


21 


MEIGS  (CHARLES   D.),  M.  D., 

Professor  of  Obstetrics,  &c.  in  the  Jefferson  Medical  College,  Philadelphia. 

ON    THE    NATURE,    SIGNS,    AND    TREATMENT    OF    CHILDBED 

FEVER.     In   a  Series  of  Letters  addressed  to  the  Students  of  his  Class.     In  one  handsome 

octavo  volume,  of  three  hundred  and  sixty-five  pages.    (Now  Ready.) 

The  instructive   and   interesting   author   of  this  |      This  book  will  add  move  to  his  fame  than  either 


of  those  which  bear  his  name.  Indeed  we  doubt 
whether  any  material  improvement  will  be  made  on 
the  teachings  of  this  volume  for  a  century  to  come, 
since  it  is  so  eminently  practical,  and  based  on  pro- 
found knowledge  of  the  science  and  consummate 
skill  in  the  art  of  healing,  and  ratified  by  an  ample 
and  extensive  experience,  such  as  few  men  have  the 
industry  or  good  fortune  to  acquire. — N.  Y.  Med. 
Gazette. 


work,  whose  previous  labors  in  the  department  of 
medicine  which  he  so  sedulously  cultivates,  have 
placed  his  countrymen  under  deep  and  abiding  obli- 
gations, again  challenges  their  admiration  in  the 
fresh  and  vigorous,  attractive  and  racy  pages  before 
us.  It  is  a  delectable  book.  *  #  #  This  treatise 
upon  child-bed  fevers  will  have  an  extensive  sale, 
being  destined,  as  it  deserves,  to  find  a  place  in  the 
library  of  every  practitioner  who  scorns  to  lag  in  the 
rear  of  his  brethren. — Nashville  Journal  of  Medi- 
cine and  Surgery. 

BY   THE   SAME   AUTHOR. 

WOMAN :  HER  DISEASES  AND  THEIR  REMEDIES.  A  Series  of  Lec- 
tures to  his  Class.  Third  and  Improved  edition.  In  one  large  and  beautifully  printed  octavo 
volume.     (Just  Issued.)     pp.  672. 

The  gratifying  appreciation  of  his  labors,  as  evinced  by  the  exhaustion  of  two  large  impressions 
of  this  work  within  a  tew  years,  has  not  been  lost  upon  the  author,  who  has  endeavored  in  every 
way  lo  render  it  worthy  of  the  favor  with  which  it  has  been  received.  The  opportunity  thus 
afforded  for  a  second  revision  has  been  improved,  and  the  work  is  now  presented  as  in  every  way 
superior  to  its  predecessors,  additions  and  alterations  having  been  made  whenever  the  advance  of 
science  has  rendered  them  desirable.  The  typographical  execution  of  the  work  will  also  be  found 
to  have  undergone  a  similar  improvement  and  the  work  is  now  confidently  presented  as  in  every 
way  worthy  the  position  it  has  acquired  as  the  standard  American  text-book  on  the  Diseases  of 
Females. 


It  contains  a  vast  amount  of  practical  knowledge, 
by  one  who  has  accurately  observed  and  retained 
the  experience  of  many  years,  and  who  tells  the  re- 
sult in  a  free,  familiar,  and  pleasant  manner. — Dub- 
lin Quarterly  Journal. 

There  is  an  off-hand  fervor,  a  glow,  and  a  warm- 
heartedness infecting  the  effort  of  Dr.  Meigs,  which 
is  entirely  captivating,  and  which  absolutely  hur- 
ries the  reader  through  from  beginning  to  end.  Be- 
sides, the  book  teems  with  solid  instruction,  and 
it  shows  the  very  highest  evidence  of  ability,  viz., 
the  clearness  with  which  the  information  is  pre- 
sented. We  know  of  no  better  test  of  one's  under- 
standing a  subject  than  the  evidence  of  the  power 
of  lucidly  explaining  it.  The  most  elementary,  as 
well  as  the  obscurest  subjects,  under  the  pencil  of 
Prof.  Meigs,  are  isolated  and  made  to  stand  out  in 


such  bold  relief,  as  to  produce  distinct  impressions 
upon  the  mind  and  memory  of  the  reader.  —  The 
Charleston  Med.  Journal. 

Professor  Meigs  has  enlarged  and  amended  this 
great  work,  for  such  it  unquestionably  is,  having 
passed  the  ordeal  of  criticism  at  home  and  abroad, 
but  been  improved  thereby  j  for  in  this  new  edition 
the  author  has  introduced  real  improvements,  and 
increased  the  value  and  utility  of  the  book  im- 
measurably. It  presents  so  many  novel,  bright, 
and  sparkling  thoughts;  such  an  exuberance  of  new 
ideas  on  almost  every  page,  that  we  confess  our- 
selves to  have  become  enamored  with  the  book 
and  its  author ;  and  cannot  withhold  our  congratu- 
lations from  our  Philadelphia  confreres,  that  such  a 
teacher  is  in  their  service. — N.  Y.  Med.  Gazette. 


BY   THE  SAME   AUTHOR. 

OBSTETRICS :  THE  SCIENCE  AND   THE   ART.     Second  edition,  revised 

and  improved.     With  one  hundred  and  thirty-one  illustrations.     In  one  beautifully  printed  octavo 
volume,  of  seven  hundred  and  fifty-two  large  pages.     (Lately  Published.) 

The  rapid  demand  for  a  second  edition  of  this  work  is  a  sufficient  evidence  that  it  has  supplied 
a  desideratum  of  the  profession,  notwithstanding  the  numerous  treatises  on  the  same  subject  which 
have  appeared  within  the  last  few  years.  Adopting  a  system  of  his  own,  the  author  has  combined 
the  leading  principles  of  his  interesting  and  difficult  subject,  with  a  thorough  exposition  of  its  rules 
of  practice,  presenting  the  results  of  long  and  extensive  experience  and  of  familiar  acquaintance 
with  all  the  modern  writers  on  this  department  of  medicine.  As  an  American  Treatise  on  Mid- 
wifery, which  has  at  once  assumed  the  position  of  a  classic,  it  possesses  peculiar  claims  to  the  at- 
tention and  study  of  the  practitioner  and  student,  while  the  numerous  alterations  and  revisions 
which  it  has  undergone  in  the  present  edition  are  shown  by  the  great  enlargement  of  the  work, 
which  is  not  only  increased  as  to  the  size  of  the  page,  but  also  in  the  number. 

BY  the  same  author.     (Lately  Published.) 

A  TREATISE  ON  ACUTE  AND  CHRONIC  DISEASES  OF  THE  NECK 

OF  THE  UTERUS.     With  numerous  plates,  drawn  and  colored  from  nature  in  the  highest 
style  of  art.    In  one  handsome  octavo  volume,  extra  cloth. 

The  object  of  the  author  in  this  work  has  been  to  present  in  a  small  compass  the  practical  results 
of  his  long  experience  in  this  important  and  distressing  class  of  diseases.  The  great  changes  intro- 
duced into  practice,  and  the  accessions  to  our  knowledge  on  the  subject,  within  the  last  few  years, 
resulting  from  the  use  of  the  metroscope,  brings  within  the  ordinary  practice  of  every  physician 
numerous  cases  which  were  formerly  regarded  as  incurable,  and  renders  of  great  value  a  work  like 
the  present  combining  practical  directions  for  diagnosis  and  treatment  with  an  ample  series  of  illus- 
trations, copied  accurately  from  colored  drawings  made  by  the  author,  alter  nature. 

BY   THE   SAME   AUTHOR. 

OBSERVATIONS   ON    CERTAIN    OF    THE    DISEASES    OF    YOUNG 

CHILDREN.     In  one  handsome  octavo  volume,  of  214  pages. 


£2 


BLANCHARD   &    LEA'S    MEDICAL. 


MACLISE   (JOSEPH),    SURGEON. 
SURGICAL   ANATOMY.     Forming  one  volume,   very  large  imperial   quarto. 

With  sixty-eight  large  and  splendid  Plates,  drawn  in  the  best  style  and  beautifully  colored.  Con- 
taining- one  hundred  and  ninety  Figures,  many  of  them  the  size  of  life.  Together  with  copious 
and  explanatory  letter-press.  Strongly  and  handsomely  bound  in  extra  cloth,  being  one  of  the 
cheapest  and  best  executed  Surgical  works  as  yet  issued  in  this  country. 

Copies  can  be  sent  by  mail,  in  five  parts,  done  up  in  stout  covers. 

This  great  work  being  now  concluded,  the  publishers  confidently  present  it  to  the  attention  of  the 
profession  as  worthy  in  every  respect  of  their  approbation  and  patronage.  No  complete  work  ot 
the  kind  has  yet  been  published  in  the  Engli>h  language,  and  it  therefore  will  supply  a  want  long 
felt  in  this  country  of  an  accurate  and  comprehensive  Atlas  of  Surgical  Anatomy  to  which  the 
student  and  practitioner  can  at  all  times  refer,  to  ascertain  the  exact  relative  position  ol  the  various 
portions  of  the  human  frame  towards  each  other  and  to  the  surface,  as  well  as  their  abnormal  de- 
viations. The  importance  of  such  a  work  to  the  student  in  the  absence  of  anatomical  material,  and 
to  the  practitioner  when  about  attempting  an  operation,  is  evident,  while  the  price  of  the  book,  not- 
withstanding the  large  size,  beauty,  and  finish  of  the  very  numerous  illustrations,  is  so  low  as  to 
place  it  within  the  reach  of  every  member  of  the  profession.  The  publishers  therefore  confidently 
anticipate  a  very  extended  circulation  for  this  magnificent  work. 


One  of  the  greatest  artistic  triumphs  of  the  age 
in  Surgical  Anatomy. — British  American  Medical 
Journal. 

Too  mueh  cannot  be  said  in  its  praise;  indeed, 
we  have  not  language  to  do  it  justice. — Ohio  Medi- 
cal and  Surgical  Journal. 

The  most  admirable  surgical  atlas  we  have  seen. 
To  the  practitioner  deprived  of  demonstrative  dis- 
sections upon  the  human  subject,  it  is  an  invaluable 
companion. — N.  J.  Medical  Reporter. 

The  most  accurately  engraved  and  beautifully 
colored  plates  we  have  ever  seen  in  an  American 
book — one  of  the  best  and  cheapest  surgical  works 
ever  published. — Buffalo  Medical  Journal. 

It  is  very  rare  that  so  elegantly  printed,  so  well 
illustrated,  and  so  useful  a  work,  is  offered  at  so 
moderate  a  price. — Charleston  Medical  Journal. 

Its  plates  can  boast  a  superiority  which  places 
them  almost  beyond  the  reach  of  competition. — Midi- 
cat  Examiner. 

Every  practitioner,  we  think,  should  have  a  work 
of  this  kind  within  reach. — Southern  Medical  and 
Surgical  Journal. 

No  such  lithographic  illustrations  of  surgical  re- 
gions have  hitherto,  we  think,  been  given. — Boston 
Medical  and  Surgical  Journal. 

As  a  surgical  anatomist,  Mr.  Maclise  has  proba- 
bly no  superior. — British  and  Foreign  Medico-Chi- 
rurgical  Review. 

Of  great  value  to  the  student  engaged  in  dissect- 
ing, and  to  the  surgeon  at  a  distance  from  the  means 


of  keeping  up  his  anatomical  knowledge. — Medical 
Times. 

The  mechanical  execution  cannot  be  excelled. — 
Transylvania  Medical  Journal. 

A  work  which  has  no  parallel  in  point  of  accu- 
racy and  cheapness  in  the  English  language. — iV.  Y. 
Journal  of  Medicine. 

To  all  engaged  in  the  study  or  practice  of  their 
profession,  such  a  work  is  almost  indispensable. — 
Dublin  Quarterly  Medical  Journal. 

No  practitioner  whose  means  will  admit  should 
fail  to  possess  it. — hanking's  Abstract. 

Country  practitioners  will  find  these  plates  of  im- 
mense value. — N.  Y.  Medical  Gazette. 

We  are  extremely  gratified  to  announce  to  the 
profession  the  completion  of  tins  truly  magnificent 
work,  which,  as  a  whole,  certainly  stands  unri- 
valled, both  for  accuracy  of  drawing,  beauty  of 
coloring,  and  all  the  requisite  explanations  of  the 
subject  in  hand. — The  New  Orleans  Medical  and 
Surgical  Journal. 

This  is  by  far  the  ablest  work  on  Surgical  Ana- 
tomy that  has  come  under  our  observation.  We 
know  of  no  other  work  that  would  justify  a  stu- 
dent, in  any  degree,  for  neglect  of  actual  dissec- 
tion. In  those  sudden  emergencies  that  so  often 
arise,  and  which  require  the  instantaneous  command 
of  minute  anatomical  knowledge,  a  work  of  this  kind 
keeps  the  details  of  the  dissecting-room  perpetually 
fresh  in  the  memory  — The  Western  Journal  of  Medi- 
cine and  Surgery. 


fi^ST1  The  very  low  price  at  which  this  work  is  furnished,  and  the  beauty  of  its  execution, 
require  an  extended  sale  to  compensate  the  publishers  tor  the  heavy  expenses  incurred. 


MULLER  (PROFESSOR  J.),   M.D. 
PRINCIPLES  OF  PHYSICS   AND   METEOROLOGY.     Edited,  with  Addi- 

tions,  by  11.  Eglesfeld  Griffith,  M.  D.     In  one  large  and  handsome  octavo  volume,  extra 
cloth,  with  550  wood-cuts,  and  two  colored  plates,    pp.  636. 

The  Physics  of  MQller  is  a  work  superb,  complete,  |  tion  to  the  scientific  records  of  this  country  may  be 
unique  :  tiie  greatest  want  known  to  English  Science  |  duly  estimated  by  the  fact  that,  the  cost  of  the  origi- 
coufd  not  have  been  better  supplied.  The  work  is  I  nal  drawings  and  engravings  alone  liaE  exceeded  the 
of  surpassing  interest.     The  value  of  this  contribu-  |  sum  of  £2,000. — Lancet. 


MAYNE  (JOHN),   M .  D.,  M .  R.  C.  S. 
A  DISPENSATORY  AND  THERAPEUTICAL  REMEMBRANCER.    Cora- 

prising  the  entire  lists  of  Materia  Medica,  with  every  Practical  Formula  contained  in  the  three 
British  Pharmacopoeias.  With  relative  Tables  subjoined,  illustrating,  by  upwards  of  six  hundred 
and  sixty  examples,  the  Extemporaneous  Forms  and  Combinations  suitable  for  the  different 
Medicines.  Edited,  with  the  addition  of  the  Formulae  of  the  United  States  Pharmacopoeia,  by 
R.  Eglesfeld  Griffith,  M.  D.    In  one  12mo.  volume,  extra  cloth,  of  over  300  large  pages. 


MATTEUCCI  (CARLO). 
LECTURES  ON  THE  PHYSICAL  PHENOMENA  OF  LIVING  BEINGS. 

Edited  by  J.  Pereira,  M.  D.     In  one  neat  royal  12mo.  volume,  extra  cloth,  with  cuts,  388  pages. 


AND    SCIENTIFIC    PUBLICATIONS. 


23 


MILLER  (JAMES),    F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     A  new  American,  from  the  third  and  revised 

Edinburgh  edition.    In  one  large  and  very  beautiful  volume,  of  about  seven  hundred  pages,  with 
two  hundred  and  forty  exquisite  illustrations  on  wood.     'Novj  Ready.) 


This  edition  is  far  superior,  both  in  the  abundance 
and  quality  of  its  material,  to  any  of  the  preceding. 
We  hope  it  will  be  extensively  read,  and  the  sound 
principles  which  are  herein  taught  treasured  up  for 
future  application.  The  work  takes  rank  with 
Watson's  Practice  of  Physic;  it  certainly  does  not 
fall  behind  that  great  work  in  soundness  of  princi- 
ple or  depth  of  reasoning  and  research.  No  physi- 
cian who  values  his  reputation,^or  seeks  the  interests 
of  his  clients,  can  acquit  himself  before  his  God  and 
the  world  without  making  himself  familiar  with  the 
sound  and  philosophical  views  developed  in  the  fore- 
going book. — New  Orleans  Med.  and  Surg.  Journal. 

Without  doubt  the  ablest  exposition  of  the  prin- 
ciples of  that  branch  of  the  healing  art  in  any  lan- 


guage. This  opinion,  deliberately  formed  after  a 
careful  study  of  the  first  edition,  we  have  had  no 
cause  to  change  on  examining  the  second.  This 
edition  has  undergone  thorough  revision  by  the  au- 
thor;  many  expressions  have  been  modified,  and  a 
mass  of  new  matter  introduced.  The  hook  is  got  up 
in  the  finest  style,  and  is  an  evidence  of  the  progress 
of  typography  in  our  country. — Charleston  Medical 
Journal  and  Review. 

We  recommend  it  to  both  student  and  practitioner, 
feeling  assured  that  as  it  now  comes  to  us,  it  pre- 
sents the  most  satisfactory  exposition  of  the  modern 
doctrines  of  the  principles  of  surgery  to  be  found  in 
any  volume  in  any  language. — N.' Y.  Journal  of 
Medicine. 


BY  the  same  author.     (Lately  Published.) 

THE  PRACTICE  OF  SURGERY.  Third  American  from  the  second  Edin- 
burgh edition.  Edited,  with  Additions,  by  F.  W.  Sargent,  M.  D  ,  one  of  the  Surgeons  to  Will's 
Hospital,  cV*c  Illustrated  by- three  hundred  and  nineteen  engravings  on  wood.  In  one  large 
octavo  volume,  of  over  seven  hundred  pages. 


No  encomium  of  ours  could  add  to  the  popularity 
of  Miller's  Surgery.  Its  reputation  in  this  country 
is  unsurpassed  by  that  of  any  other  work,  and,  when 
taken  in  connection  with  the  author's  Principles  of 
Surgery,  constitutes  a  whole,  without  reference  to 
which  no  conscientious  surgeon  would  be  willing 
to  practice  his  art  The  additions,  by  Dr.  Sargent, 
have  materially  enhanced  the  value  of  the  work. — 
Southern  Medical  and  Surgical  Journal. 

It  is  seldom  that  two  volumes  have  ever  made  so 
profound  an  impression  in  so  short  a  time  as  the 
"  Principles"  and  the  "  Practice"  of  Surgery  by 
Mr.  Miller — or  so  richly  merited  the  reputation  they 
have  acquired.  The  author  is  an  eminently  sensi- 
ble, practical,  and  well-informed  man,  who  knows 
exactly  what  he  is  talking  about  and  exactly  how  to 
talk  it. — Kentucky  Medical  Recorder. 

The  two  volumes  together  form  a  complete  expose 
of  the  present  state  of  Surgery,  and  they  ought  to  be 
on  the  shelves  of  every  surgeon. — N.  J.  Med.  Re- 
porter. 


By  the  almost  unanimous  voice  of  the  profession, 
his  works,  both  on  the  principles  and  practice  of 
surgery  have  been  assigned  the  highest  rank.  If  we 
were  limited  to  but  one  work  on  surgery,  that  one 
should  be  Miller's,  as  we  regard  it  as  superior  to  all 
others. — St.  Louis  Med.  and  Surg.  Journal. 

The  author  distinguished  alike  as  a  practitioner 
and  writer,  has  in  this  and  his  il  Principles,"  pre- 
sented to  the  profession  one  of  the  most  completeand 
reliable  systems  of  Surgery  extant.  His  style  of 
writing  is  original,  impressive,  and  engaging,  ener- 
getic, concise,  and  lucid.  Few  have  the  faculty  of 
condensing  so  much  in  small  space,  and  at  the  same 
time  so  persistently  holding  the  attention;  indeed, 
he  appears  to  make  the  very  process  of  condensation 
a  means  of  eliminating  attractions.  Whether  as  a 
text-book  for  students  or  a  book  of  reference  for 
practitioners,  it  cannot  be  too  strongly  recommend- 
ed.— Southern  Journal  of  the  Medical  and  Physical 
Sciences. 


MALGAIGNE  (J.  F.). 
OPERATIVE  SURGERY,  based  on  Normal  and  Pathological  Anatomy.     Trans- 

lated  from  the  French,  by  Frederick  Brittan,  A.  B.,  M.  D.    With  numerous  illustrations  on 
wood.     In  one  handsome  octavo  volume,  of  nearly  six  hundred  pages. 


MOHR  (FRANCIS)    PH.D.,  AND   RED  WOO  D  (TH  EOPH  I  LUS). 
PRACTICAL    PHARMACY.     Comprising  the  Arrangements,  Apparatus,  and 
Manipulations  of  the  Pharmaceutical  Shop  and  Laboratory.    Exiled,  with  extensive  Additions, 
by  Prof.  William  Procter,  of  the  Philadelphia  College  of  Pharmacy.     In  one  handsomely 
printed  octavo  volume,  of  570  pages,  with  over  500  engravings  on  wood. 

NEILL   (JOHN),    M.  D., 

Professor  of  Surgery  in  the  Pennsylvania  Medical  College,  &c. 

OUTLINES  OF  THE  ARTERIES.     With  short  Descriptions.     Designed   for 

the  Use  of  Medical  Students.     With  handsome  colored  plates.    Second  and  improved  edition. 
In  one  octavo  volume,  extra  cloth. 

OUTLINES  OF  THE  NERVES.     With  short  Descriptions.     Designed  for  the 

Use  of  Medical  Students.    With  handsome  plates.    Second  and  improved  edition.    In  one  octavo 
volume,  extra  cloth. 

OUTLINES  OF  THE  VEINS  AND  LYMPHATICS.  With  short  Descrip- 
tions. Designed  for  the  Use  of  Medical  Students.  With  handsome  colored  plates.  In  one  octavo 
volume,  extra  cloth. 

ALSO — The  three  works  done  up  in  one  handsome  volume,  half  bound,  with  numerous  plates,  pre- 
senting a  complete  view  of  the  Circulatory,  Nervous,  and  Lymphatic  Systems. 


This  book  should  be  in  the  hand  of  every  medical 
Btudent.  It  is  cheap,  portable,  and  precisely  the 
thing  needed  in  studying  an  important,  though  diffi- 
cult part  of  Anatomy.  —  Boston  Med.  and  Surg. 
Journal. 

We  recommend  every  student  of  medicine  to  pur- 
chase a  copy  of  this  work,  as  a  labor-saving  ma- 
chine, admirably  adapted  to  refresh  the  memory, 
with  knowledge  gained   by   lectures,   dissections, 


and  the  reading  of  larger  works. — N.  Y.  Journal  of 
Medicine. 

This  work  is  from  the  pen  of  a  Philadelphia  ana- 
tomist, whose  familiar  knowledge  of  the  subject  has 
been  aided  by  the  press,  the  result  of  which  is  a  vo- 
lume of  great  beauty  and  excellence.  Its  fine  exe- 
cution commends  it  to  the  siudent  of  Anatomy.  It 
requires  no  other  recommendations. —  Western  Jvurn. 
of  Medicine  and  Surgery. 


24  BLANCHARD    &    LEA'S    MEDICAL 

NEILL  (JOHN),   M.  D., 

Surgeon  to  the  Pennsylvania  Hospital ,  &c .;  and 
FRANCIS  GURNEY   SMITH,   M.  D., 

Professor  of  Institutes  of  Medicine  in  the  Pennsylvania  Medical  College. 

AN  ANALYTICAL   COMPENDIUM    OF   THE   VARIOUS   BRANCHES 

OF  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.  A  new  edition,  revised 
and  improved.  In  one  very  large  and  handsomely  printed  royal  12mo.  volume,  of  about  one 
thousand  pages,  with  three  hundred  and  seventy-four  illustrations  on  wood.  Strongly  bound  in 
leather,  with  raised  bands.     [Now  Ready.) 

The  speedy  sale  of  a  large  impression  of  this  work  has  afforded  to  the  authors  gratifying  evidence 
of  the  correctness  of  the  views  which  actuated  Ihem  in  its  preparation.  In  meeting  the  demand 
for  a  second  edition,  they  have  therefore  been  desirous  to  render  it  more  worthy  of  the  favor  with 
which  it  has  been  received.  To  accomplish  this,  they  have  spared  neither  time  nor  labor  in  embo- 
dying in  it  such  discoveries  and  improvements  as  have  been  made  since  its  first  appearance,  and 
such  alterations  as  have  been  suggested  by  its  practical  use  in  the  class  and  examination-room. 
Considerable  modifications  have  thus  been  introduced  throughout  all  the  departments  treated  of  in 
the  volume,  but  more  especially  in  the  portion  devoted  to  the  "Practice  of  Medicine,"  which  has 
been  entirely  rearranged  and  rewritten. 

Notwithstanding  the  enlarged  size  and  improved  execution  of  this  work,  the  price  has  not  been 
increased,  and  it  is  confidently  presented  as  one  of  the  cheapest  volumes  now  before  the  profession. 

Having  made  free  use  of  this  volume  in  our  ex- 
aminations of  pupils,  we  can  speak  from  experi- 
ence in  recommending  it  as  an  admirable  compend 
for  students,  and  as  especially  useful  to  preceptors 
who  examine  their  pupils.  It  will  save  the  teacher 
much  labor  by  enabling  him  readily  to  recall  all  of 
the  points  upon  which  his  pupils  should  be  ex- 
amined. A  work  of  this  sort  should  be  in  the  hands 
of  every  one  who  takes  pupils  into  his  office  with  a 
view  of  examining  them;  and  this  is  unquestionably 
the  bestof  its  class.  Let  every  practitioner  who  has 
pupils  provide  himself  with  it,  and  he  will  find  the 
labor  of  refreshing  his  knowledge  so  much  facilitated 
that  he  will  be  able  to  do  justice  to  his  pupils  at  very 
little  cost  of  time  or  trouble  to  himself. — Transyl- 
vania Med.  Journal. 


In  the  rapid  course  of  lectures,  where  work  for 
the  students  is  heavy,  and  review  necessary  for  an 
examination,  a  compend  is  not  only  valuable,  but 
it  is  almost  a  sine  qua  non.  The  one  before  us  is, 
in  most  of  the  divisions,  the  most  unexceptionable 
of  all  books  of  the  kind  that  we  know  of.  The 
newest  and  soundest  doctrines  and  the  latest  im- 
provements and  discoveries  are  explicitly,  though 
concisely,  laid  before  the  student.  Of  course  it  is 
useless  for  us  to  recommend  it  to  all  last  course 
students,  but  there  is  a  class  to  whom  we  very 
sincerely  commend  this  cheap  book  as  worth  its 
weight  in  silver  —  that  class  is  the  graduates  in 
medicine  of  more  than  ten  years'  standing,  who 
have  not  studied  medicine  since.  They  will  perhaps 
find  out  from  it  that  the  science  is  not  exactly  now 
what  it  was  when  they  left  it  off. — The  Stethoscope 


NELIGAN  (J.    MOORE),  M.  D.,  M.  R.  I.  A.,  &c. 
A   PRACTICAL   TREATISE    ON   DISEASES    OF   THE    SKIN.     In  one 

neat  royal  12mo.  volume,  of  334  pages. 

BY  THE  SAME  AUTHOR.      (JllSt  Ready.) 

ATLAS  OF  CUTANEOUS  DISEASES.     In  one  beautiful  quarto  volume,  with 

splendid  Colored  plates,  presenting  nearly  one  hundred  elaborate  representations  of  disease. 

This  beautiful  volume  is  intended  to  accompany  the  author's  "  Treatise  on  Diseases  of  the  Skin," 
so  favorably  received  by  the  profession  some  vears  since.  In  the  description  of  the  plates,  reference 
is  made  to  the  chapter  and  page  of  the  "  Treatise,"  so  that  together  the  two  constitute,  at  a  much 
smaller  cost  than  has  been  hitherto  attempted,  a  complete  work  of  reference  for  the  Diagnosis  and 
Treatment  of  this  difficult  class  of  diseases,  which,  more  than  any  other,  perhaps,  require  this  mode 
of  pictorial  elucidation. 

Dr.  Neligan  deserves  our  best  thanks  for  this  i  ence  to  the  chapter  of  that  work  where  the  disease 
attempt  to  supply  a  want  which  has  been  long  felt,  j  receives  special  mention.  Great  care  has  evidently 
For  a  small  sum  he  here  presents  us  with  an  Atlas  ,  been  taken  to  procure  proper  subjects  for  the  artist 
containing  some  ninety  plates  of  the  more  com-  and  the  daguerreotype,  which  has  been  employed  in 
mon  and  rarer  forms  of  affections  of  the  skin,  and  ;  several  of  the  plates,  "  to  secure  correctness  in  the 
for  the  benefit  of  those  who  possess  his  useful  I  design." — Edinburgh  Medical  Journal,  September, 
Manual,  he  supplies  with  each  illustration  a  refer-  |  1855. 


OWEN  (PROF.    R.), 

Author  of"  Lectures  on  Comparative  Anatomy,"  "  Archetype  of  the  Skeleton,"  &c. 

ON  THE  DIFFERENT  FORMS  OF  THE  SKELETON,  AND  OF  THE 

TEETH.     One  vol.  royal  12mo.,  with  numerous  illustrations.     (Just  Issued.) 

PANCOAST  (J.),  M.  D., 
Professor  of  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia,  ice. 

OPERATIVE  SURGERY;  or,  A  Description  and  Demonstration  of  the  various 

Processes  of  the  Art ;  including  all  the  New  Operations,  and  exhibiting  the  State  of  Surgical 
Science  in  its  present  advanced  condition.  Complete  in  one  royal  4lo.  volume,  of  380  pages  of 
letter-press  description  and  eighty  large  4to.  plates,  comprising  486  illustrations.  Second  edition, 
improved. 

This  excellent  work  is  constructed  on  the  model  cerned,  we  are  proud  as  an  American  to  say  that, 
of  the  French  Surgical  Works  by  Velpeau  and  Mai-  of  its  kixd  it  has  no  superior. — N.  Y.  Journal  of 
gaigne;  and,  so  far  as  the  English  language  is  con-     Medicine. 


PARKER   (LANGSTON), 

Surgeon  to  the  Queen's  Hospital,  Birmingham. 

THE  MODERN  TREATMENT  OF  SYPHILITIC  DISEASES,  BOTH  PRI- 
MARY" AND  SECONDARY;  comprising  the  Treatment  of  Constitutional  and  Confirmed  Syphi- 
lis, by  a  safe  and  successful  method.  With  numerous  Cases,  Formulfe,  and  Clinical  Observa- 
tions.    From  the  Third  and  entirely  rewritten  London  edition.     In  one  neat  octavo  volume, 


AND   SCIENTIFIC    PUBLICATIONS. 


25 


(Noiv  Complete.) 

PEREIRA  (JONATHAN),  M.  D.,  F.  R.  S.,  AND  L.  S. 

THE    ELEMENTS    OF   MATERIA    MEDICA    AND    THERAPEUTICS. 

Third  American  edition,  enlarged  and  improved  by  the  author;  including  Notices  of  most  of  the 
Medicinal  Substances  in  use  in  the  civilized  world,  and  forming  an  Encyclopaedia  of  Materia 
Medica.  Edited,  with  Additions,  by  Joseph  Carson,  M.  D.,  Professor  of  Materia  Medica  and 
Pharmacy  in  the  University  of  Pennsylvania.  In  two  very  large  octavo  volumes  of  2100  pages, 
on  small  type,  with  over  four  hundred  and  fifty  illustrations. 
Volume  I. — Lately  issued,  containing  the  Inorganic  Materia  Medica,  over  800  pages,  with  145 

illustrations. 
Volume  II. — Now  ready,  embraces  the  Organic  Materia  Medica,  and  forms  a  very  large  octavo 
volume  of  1250  pages,  with  two  plates  and  three  hundred  handsome  wood-cuts. 
The  present  edition  of  this  valuable  and  standard  work  will  enhance  in  every  respect  its  well- 
deserved  reputation.  The  care  bestowed  upon  its  revision  by  the  author  may  be  estimated  by  the 
fact  that  its  size  has  been  increased  by  about  five  hundred  pages.  These  additions  have  extended 
to  every  portion  of  the  work,  and  embrace  not  only  the  materials  afforded  by  the  recent  editions  of 
the  pharmacopoeias,  but  also  all  the  important  information  accessible  to  the  care  and  industry  of 
the  author  in  treatises,  essays,  memoirs,  monographs,  and  from  correspondents  in  various  parts  of 
the  globe.  In  this  manner  the  work  comprises  the  most  recent  and  reliable  information  respecting 
all  the  articles  of  the  Materia  Medica,  their  natural  and  commercial  history,  chemical  and  thera- 
peutical properties,  preparation,  uses,  doses,  and  modes  of  administration,  brought  up  to  the  present 
lime,  with  a  completeness  not  to  be  met  with  elsewhere.  A  considerable  portion  of  the  work 
which  preceded  the  remainder  in  London,  has  also  enjoyed  the  advantage  of  a  further  revision  by 
the  author  expressly  for  this  country,  and  in  addition  to  this  the  editor,  Professor  Carson,  has  made 
whatever  additions  appeared  desirable  to  adapt  it  thoroughly  to  the  U.  S.  Pharmacopoeia,  and  to 
the  wants  of  the  American  profession.  An  equal  improvement  will  likewise  be  observable  in  every 
department  of  its  mechanical  execution.  It  is  printed  from  new  type,  on  good  white  paper,  with  a 
greatly  extended  and  improved  series  of  illustrations. 

Gentlemen  who  have  the  first  volume  are  recommended  to  complete  their  copies  without  delay. 
The  first  volume  will  no  longer  be  sold  separate. 

When  we  remember  that  Philology,  Natural  His-  [  Medica,  although  completed  under  the  supervision  of 
tory,  Botany,  Chemistry,  Physics,  anil  the  Micro-  I  others,  is  by  far  the  most  elaborate  treatise  in  the 
scope,  are  all  brought  forward  to  elucidate  the  sub-  |  English  language,  and  will,  while  medical  literature 
ject,  one  cannot  fail  to  see  that  the  reader  has  here  ,  is  cherished,  continue  a  monument  alike  honorable 
a  work  worthy  of  the  name  of  an  encyclopedia  of  j  to  his  genius,  as  to  his   learning  and  industry. — 


Materia  Medica.  Our  own  opinion  of  its  merits  is 
that  of  its  editors,  and  also  that  of  the  whole  profes- 
sion, both  of  this  and  foreign  countries— namely, 
'•  that  in  copiousness  of  details,  in  extent,  variety, 
and  accuracy  of  information,  and  in  lucid  explana- 
tion of  difficult  and  recondite  subjects,  it  surpasses 
all  other  works  on  Materia  Medica  hitherto  pub- 
lished." We  cannot  close  this  notice  without  allud- 
ing to  the  special  additions  of  the  American  editor, 
which  pertain  to  the  prominent  vegetable  produc- 
tions of  this  country,  and  to  the  directions  of  the 
United  States  Pharmacopoeia,  in  connection  with  all 
the  articles  contained  in  the  volume  which  are  re- 
ferred toby  it.  The  illustrations  have  been  increased, 
and  this  edition  by  Dr.  Carson  cannot  well  be  re- 
garded in  any  other  light  than  that  of  a  treasure 
which  should  be  found  in  the  library  of  every  physi- 
cian.— New  York  Journal  of  Medical  and  Collateral 
Science,  March,  1854. 

The  third  edition  of  his  "Elements  of  Materia 


American  Journal  of  Pharmacy,  March,  1854. 

The  work,  in  its  present  shape,  and  so  far  as  can 
be  judged  from  the  portion  before  the  public,  forms 
the  most  comprehensive  and  complete  treatise  on 
materia  medica  extant  in  the  English  language. — 
Dr.  Pereira  has  been  at  great  pains  to  introduce 
into  his  work,  not  only  all  the  information  on  the 
natural,  chemical,  and  commercial  history  of  medi- 
cines, which  might  be  serviceable  to  the  physician 
and  surgeon,  but  whatever  might  enable  his  read- 
ers to  understand  thoroughly  the  mode  of  prepar- 
ing and  manufacturing  various  articles  employed 
either  for  preparing  medicines,  or  for  certain  pur- 
poses in  the  arts  connected  with  materia  medica 
and  the  practice  of  medicine.  The  accounts  of  the 
physiological  and  therapeutic  effects  of  remedies  are 
given  with  great  clearness  and  accuracy,  and  in  a 
manner  calculated  to  interest  as  well  as  instruct 
the  reader. — The  Edinburgh  Medical  and  Surgical 
Journal. 


PEASLEE  (E.  R.),   M.  D., 

Professor  of  Anatomy  and  Physiology  in  Dartmouth  College,  &c. 

HUMAN  HISTOLOGY,  in  its  applications  to  Physiology  and  General  Pathology; 

designed  as  a  Text-Book  for  Medical  Students.    With  numerous  illustrations.     In  one  handsome 

royal  12mo.  volume.     [Preparing.) 

The  subject  of  this  work  is  one,  the  growing  importance  of  which,  as  the  basis  of  Anatomy  and 
Physiology,  demands  for  it  a  separate  volume.  The  book  will  therefore  supply  an  acknowledged 
deficiencyin  medical  text-books,  while  the  name  of  the  author,  and  his  experience  as  a  teacher  for 
the  las.t  thirteen  years,  is  a  guarantee  that  it  will  be  thoroughly  adapted  to  the  use  of  the  student. 


P1RRIE  (WILLIAM),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE    PRINCIPLES  AND  PRACTICE  OF   SURGERY.    Edited  by  John 

Neill,  M.  D.,  Professor  of  Surgery  in  the  Penna.  Medical  College,  Surgeon  to  the  Pennsylvania 
Hospital,  &c.     In  one  very  handsome  octavo  volume,  of  780  pages,  with  316  illustrations. 


We  know  of  no  other  surgical  work  of  a  reason- 
able size,  wherein  there  is  so  much  theory  and  prac- 
tice, or  where  subjects  are  more  soundly  or  clearly 
taught. — The  Stethoscope. 

There  is  scarcely  a  disease  of  the  bone  or  soft 
rmrts,  fracture,  or  dislocation,  that  is  not  illustrated 
by  accurate  wood-engravings.  Then,  again,  every 
instrument  employed  by  the  surgeon  is  thus  repre- 
sented. These  engravings  are  not  only  correct,  but 
really  beautiful,  showing  the  astonishing  degree  of 
perfection  to  which  the  art  of  wood-engraving  has 


arrived.  Prof.  Pirrie,  in  the  work  before  us,  has 
elaborately  discussed  the  principles  of  surgery,  and 
a  safe  and  effectual  practice  predicated  upon  them. 
Perhaps  no  work  upon  this  subject  heretofore  issued 
is  so  full  upon  the  science  of  the  art  of  surgery. — 
Nashville  Journal  of  Medicine  and  Surgery. 

One  of  the  best  treatises  on  surgery  in  the  English 
language. — Canada  Med.  Journal. 

Our  impression  is,  that,  as  a  manual  for  students, 
Pirrie's  is  the  best  work  extant. —  Western  Med.  and 
Surg.  Journal. 


26  BLANCHARD    &    LEA'S    MEDICAL 

PARRISH    (EDWARD), 

Lecturer  on  Practical  Pharmacy  and  Materia  Medica  in  the  Pennsylvania  Academy  of  Medicine,  &c. 

A  PRACTICAL  INTRODUCTION   TO  PHARMACY.     Designed  as  a  Text- 

Book  for  the  Student,  and  as  a  Guide  to  the  Physician  and  Pharmaceutist.  With  numerous 
Formulae  and  over  200  Illustrations.  In  one  handsome  octavo  volume.  (Now  Ready.) 
The  want  of  an  elementary  textbook  on  this  subject  has  long-  been  felt  and  acknowledged 
While  vast  stores  of  information  on  all  the  collateral  brandies  of  pharmacy  are  contained  in  such 
works  as  Mohr  and  Redwood,  the  U.  S.  Dispensatory,  the  Pharmacopoeia,  Pereira,  and  others, 
there  has  been  no  compendious  manual  presenting  wiihin  a  moderate  compass,  and  in  systematic 
order,  the  innumerable  minor  details  which  make  up  the  everyday  business  of  those  who  dispense 
medicines.  It  has  been  the  object  of  the  author  to  supply  this  want,  and  while  to  the  pharmaceutist 
such  a  work  is  manifestly  indispensable,  its  utility  will  hardly  be  less  to  the  country  practitioner, 
residing  at  a  distance  from  drug  stores,  and  obliged  to  dispense  the  remedies  which  he  prescribes. 
Familiarized  with  the  elements  of  therapeutics  and  the  essentials  of  materia  medica,  by  his  at- 
tendance at  lectures,  he  has  hitherto  been  obliged  to  learn  for  himself  the  details  of  prescribing, 
compounding,  and  preparing  medicines.  The  volume  commences  with  a  chapter  on  the  "outfit" 
of  the  country  physician,  describing  the  different  articles,  their  various  kinds  and  comparative  ad- 
vantages; the  Pharmacopoeia  is  described,  explained,  and  commented  upon,  its  contents  classified 
and  arranged  so  as  to  be  easily  comprehended  and  referred  to;  all  the  operations  of  pharmacy  are 
given  in  minute  detail,  and  under  each  head  the  various  preparations  are  specified  to  which  it  is 
applicable,  with  directions  for  making  them,  giving  in  this  manner  a  comprehensive  and  practical 
view  of  the  materia  medica,  with  much  valuable  information  regarding  all  the  more  important  ar- 
ticles. All  the  officinal  formulae  are  thus  presented,  with  directions  for  their  preparation  and  use, 
together  with  many  empirical  ones  of  interest,  and  numerous  new  ones  derived  from  the  praclice 
of  distinguished  physicians.  Especial  attention  lias  been  bestowed  on  the  new  remedies,  the 
more  important  of  which  are  minutely  described,  particularly  those  derived  from  our  indigenous 
plants,  which  have  of  late  attracted  so  much  attention,  and  which  the  author  has  thoroughly 
investigated.  The  chapters  on  extemporaneous  pharmacy  contain  clear  and  accurate  instructions 
for  writing  prescriptions,  selecting,  combining,  dispensing,  and  compounding  medicines,  making 
powders,  piils,  mixtures,  ointments,  &c.  &c,  with  formulae;  and  the  work  concludes  with  an  ap- 
pendix of  valuable  hints  and  advice  to  those  purchasing  articles  connected  with  their  profession. 
Numerous  tables  interspersed  throughout  elucidate  the  various  subjects,  which  are  rendered  still 
clearer  by  a  large  number  of  engravings.  Care  lias  been  taken  in  all  instances  to  indicate  and 
describe  the  simplest  apparatus  and  procedures  affording  satisfactory  results.  The  long  experience 
of  the  author,  both  as  a  teacher  of  pharmacy,  and  as  a  practical  pharmaceutist,  is  BUfficienl  guarantee 
of  his  familiarity  with  the  wants  and  necessities  of  the  student,  and  of  his  ability  to  satisfy  them. 


ROKITANSKY  (CARD,    M.D., 
Curator  of  the  Imperial  Pathological  Museum,  and  Professor  at  the  University  of  Vienna,  Ice. 

A    MANUAL    OF    PATHOLOGICAL    ANATOMY.     Four   volumes  octavo, 

bound  in  two.     (Now  Ready.) 
Vol.  I. — Manual  of  General  Pathological  Anatomy.     Translated  by  W.  E.  Swaine. 
Vol.  II.— Pathological  Anatomy  of  the  Abdominal  Viscera.     Translated  by  Edward  Sieveking, 

M.  D. 
Vol.  III. — Pathological  Anatomy  of  the  Bones,  Cartilages,  Muscles,  and  Skin,  Cellular  and  Fibrous 

Tissue,  Serous  and  Mucous  Membrane,  and  Nervous  System.     Translated  by  C.  H.  Moore. 
Vol.  IV. — Pathological  Anatomy  of  the  Organs  of  Respiration  and  Circulation.     Translated  bv  G. 

E.  Day. 
To  render  this  large  and  important  work  more  easy  of  reference,  and  at  the  same  time  less  cum- 
brous and  costly,  the  publishers  have  arranged  the  four  volumes  in  two,  retaining,  however,  the 
separate  paging,  &c. 

The  publishers  feel  much  pleasure  in  presenting  to  the  profession  of  the  United  States  the  great 
work  of  Prof.  Rokitansky,  which  is  universally  referred  to  as  the  standard  of  authority  by  the  pa- 
thologists of  all  nations.  Under  the  auspices  of  the  Sydenham  Society  of  London,  the  combined 
labor  of  four  translators  has  at  length  overcome  the  almost  insuperable  difficulties  which  have  so 
long  prevented  the  appearance  of  the  work  in  an  English  dress,  while  the  additions  made  from 
various  papers  and  essays  of  the  author  present  his  views  on  all  the  topics  embraced,  in  their  latest 
published  form.  To  a  work  so  widely  known,  eulogy  is  unnecessary,  and  the  publishers  would 
merely  slate  that  it  contains  the  results  of  not  less  than  thirty  thousand  post-morte.m  examina- 
tions made  by  1  he  author,  diligently  compared,  generalized,  and  wrought  into  one  complete  and 
harmonious  system. 


R1GBY  (EDWARD),   M.D., 
Physician  to  the  General  Lying-in  Hospital,  &e. 

A   SYSTEM   OF   MIDWIFERY.     With   Notes  and   Additional  Illustrations. 

Second  American  Edition.     One  volume  octavo,  422  pages. 


ROYLE  (J.  FORBES),   M.  D. 
MATERIA  MEDICA  AND  THERAPEUTICS;  including  the  Preparations  of 

the  Pharmacopoeias  of  London,  Edinburgh,  Dublin,  and  of  the  United  States.  With  many  new 
medicines.  Edited  by  Joseph  Carson,  M.  D.,  Professor  of  Materia  Medica  and  Pharmacy  in 
the  University  of  Pennsylvania.  With  ninety-eight  illustrations.  In  one  large  octavo  volume, 
of  about  seven  hundred  pages. 


This  work  is,  indeed,  a  most  valuable  one,  and 
will  fill  up  an  important  vacancy  that  existed  be- 
tween Dr.  Pereira's  most  learned  and  complete 
system  of  Materia  Medica,  and   the  class  of  pro- 


ductions on  the  other  extreme,  which  are  neces- 
sarily imperfect  from  their  small  extent. — British 
and  Foreign  Medical  Review. 


AND    SCIENTIFIC    PUBLICATIONS. 


27 


RAMSBOTHAM  (FRANCIS  H.),   M.D. 
THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 

SURGERY,  in  reference  to  the  Process  of  Parturition.    A  new  and  enlarged  edition,  thoroughly 
revised  by  the  Author.     With  Additions  by  W.  V.  Keating,  M.  D.     In  one  large  and  handsome 
imperial  oclavo  volume,  of  650  pages,  with  sixty-four  beautiful  Plates,  and  numerous  Wood-cuts 
in  the  text,  containing  in  all  nearly  two  hundred  large  and  beautiful  figures.  (Now  Ready.) 
In  calling  the  attention  of  the  profession  to  the  new  edition  of  this  standard  work,  the  publishers 
would  remark  that  no  efforts  have  been  spared  to  secure  for  it  a  continuance  and  extension  of  the 
remarkable  favor  with  which  it  has  been  received.     The  last  London  issue,  which  was  considera- 
bly enlarged,  has  received  a  further  revision  from  the  author,  especially  for  this  country.     Its  pas- 
sage through  the  press  here  has  been  supervised  by  Dr.  Keating,  who  has  made  numerous  addi- 
tions with  a  view  of  presenting  more  fully  whatever  was   necessary  to  adapt  it  thoroughly  to 
American  modes  of  practice.     In  its  mechanical  execution,  a  like  superiority  over  former  editions 
will  be  found.     The  plates  have  all  been  re-engraved  in  a  new  and  beautiful  style  ;  many  additional 
illustrations  have  been  introduced,  and  in  every  point  of  typographical  finish  it  will  be  found  one  of 
the  handsomest  issues  of  the  American  press.     In  its  present  improved  and  enlarged  form  the  pub- 
lishers therefore  confidently  ask  for  it  a  place  in  every  medical  library,  as  a  text-book  for  the  student, 
or  a  manual  for  daily  reference  by  the  practitioner. 

From  Prof.  Hodge,  of  the  University  of  Pa. 
To   the  American  public,  it  is  most  valuable,  from  its  intrinsic  undoubted  excellence,  and  as  being 
the  best  authorized  exponent  of  British  Midwifery.    Its  circulation  will,  I  trust,  be  extensive  throughout 
our  country. 

The  publishers  have  shown  their  appreciation  of ;  cine  and   Surgery  to   our   library,  and  confidently 
the  merits  of  this  work  and  secured  its  success  by    recommend  it  to  our  readers,  with   the  assurance 
the  truly  elegant  style  in  which  they  have  brought    that  it  will  not  disappoint  their  most  sanguine  ex- 
it out,  excelling  themselves  in  its  production,  espe-  I  pectations. —  Western  Lancet. 
cially  in  its  plates.     It  is  dedicated  to  Prof.  Meigs, 


and  has  the  emphatic  endorsement  of  Prof.  Hodge, 
as  the  best  exponent  of  British  Midwifery.  Wc 
know  of  no  text-book  which  deserves  in  all  respects 
to  be  more  highly  recommended  to  studeuts,  and  we 
could  wish  to  see  it  in  the  hands  of  every  practitioner, 
for  they  will  find  it  invaluable  for  reference. — Med. 
Gazette. 


It  is  unnecessary  to  say  anything  in  regard  to  the 
utility  of  this  work.  It  is  already  appreciated  in  our 
country  for  the  value  of  the  matter,  the  clearness  of 
its  style,  and  the  fulness  of  its  illustrations.  To  the 
physician's  library  it  is  indispensable,  while  to  the 
student  as  a  text-book,  from  which  to  extract  the 
material  for  laying  the  foundation  of  an  education  on 
obstetrical  science,  it  has  no  superior. — Ohio  Med. 
and  Surg.  Journal. 


We  will  only  add  that  the  student  will  learn  from 
it  all  he  need  to  know,  and  the  practitioner  will  find 


But  once  in  a  long  time  some  brilliant  genius  rears 
bis  head  above  the  horizon  of  science,  and  illumi- 
nates and  purifies  every  department  that  he  investi- 
gates ;  and  his  works  become  types,  by  which  innu-    . 

merable  imitators  model  their  feeble  productions,  it- as  a  book  of  reference,  surpassed  by  none  other.— 
Such  a  genius  we  lind  in  the  younger  Ramsbotham,    Stethoscope. 

and  such  a  type  we  find  in  the  work  now  before  us.  The  character  and  merits  of  Dr.  Ramsbothara's 
The  binding,  p;'per,  type,  the  engravings  and  wood-  t  work  are  so  well  known  and  thoroughly  established, 
cuts  are  all  so  excellent  as  to  make  this  book  one  of  i  that  comment  is  unnecessary  and  praise  superfluous, 
the  finest  specimens  of  the  art  of  printing  that  have  The  illustrations,  which  are  numerous  and  accurate, 
given  such  a  world-wide  reputation  to  its  cnterpri-  j  are  executed  in  the  highest  style  of  art.  We  cannot 
sins'  and  liberal  publishers.  We  welcome  Rams- !  too  highly  recommend  the  work  to  our  readers. — St. 
boiham's  Principles  and  Practice  of  Obstetric  Medi-  i  Louis  Med.  and  Surg.  Journal. 


RICORD  (P.),   M.  D., 

Surgeon  to  the  Hopital  du  Midi,  Paris,  ice. 

ILLUSTRATIONS  OF  SYPHILITIC  DISEASE.  Translated  from  the  French, 

by  Thomas  F.  Betton,  M.  D.  With  the  addition  of  a  History  of  Syphilis,  and  a  complete  Bib- 
liography and  Formulary  of  Remedies,  collated  and  arranged,  by  Paul  B.  Goddard,  M.  D.  With 
fifty  large  quarto  plates,  comprising  one  hundred  and  seventeen  beautifully  colored  illustrations, 
hi  one  large  and  handsome  quarto  volume. 

by  the  same  author.     (Lately  Publislted.) 

A  TREATISE  ON  THE  VENEREAL  DISEASE.     By  John  Hunter,  F.  R.  S. 

With  copious  Additions,  by  Ph.  Ricord,  M.  D.  Edited,  with  Notes,  by  Freeman  J.  Bumstead, 
M.  D.     In  one  handsome  octavo  volume,  of  520  pages,  with  plates. 


Kvery  one  will  recognize  the  attractiveness  and 
value  which  this  work  derives  from  thus  presenting 
the  opinions  of  these  two  masters  side  by  side.  But, 
K  must  be  admitted,  what  has  made  tiie  fortune  of 
the  book,  is  i lie  fact  that  it  contains  the  "most  com- 
plete embodiment  of  the  veritable  doctrines  of  the 
Hopital  du  Midi,"  which  has  ever  been  made  public. 
The  doctrinal  ideas  of  M.  Ricord,  ideas  which,  if  not 
universally  adopted,  are  incontestably  dominant,  have 
heretofore  only  been  interpreted  by  more  or  less  skilful 
secretaries,  sometimes  accredited  and  sometimes  not. 


In  the  notes  to  Hunter,  the  mister  substitutes  him- 
selfforhis  interpreters,  and  gives  his  original  thoughts 
to  the  world,  in  a  summary  form  it  is  true,  but  in  a 
lucid  and  perfectly  intelligible  manner.  In  eonclu 
sion  we  can  say  that  this  is  incontestably  the  best 
treatise  on  syphilis  with  which  wc  are  acquainted, 
and,  as  we  do  not  often  employ  the  phrase,  we  may 
be  excused  for  expressing  the  hope  that  it  may  find 
a  place  in  the  library  of  every  physician — Virginia 
Med.  and  Stcrg.  Journal. 


BY   THE   SAME   AUTHOR. 

LETTERS  ON  SYPHILIS,  addressed  to  the  Chief  Editor  of  the  Union  Medieale. 

With  an  Introduction,  by  Amedee  Latour.     Translated  by  \V.  P.  Laltimore,  M.  D.     In  one  neat 
octavo  volume  of  270  pages. 

»  BY   THE   SAME   AUTHOR. 

A  PRACTICAL  TREATISE  ON  VENEREAL  DISEASES.     With  a  Thcra- 

peutical  Summary  and  Special  Formulary.    Translated  by  Sidney  Doane,  M.  D.    Fourth  edition. 
One  volume,  octavo,  ,110  pages. 


28 


BLANCHARD    &    LEA'S  "MEDICAL 


SMITH    (HENRY    H.), 

Professor  of  Surgery  in  the  University  of  I  enns   tvania,  &c. 

MINOR  SURGERY;  or,  Hints  on  the  E very-day  Duties  of  the  Surgeon.  Illus- 
trated by  two  hundred  and  forty-seven  illustrations.  Third  and  enlarged  edition.  In  one  hand- 
some royal  12mo.  volume,     pp.  456. 


And  a  capital  little  book  it  is.  .  .  Minor  Surgery, 
we  repeat,  is  really  Major  Surgery,  and  anything 
which  teaches  it  is  worth  having.  So  we  cordially 
recommend  this  little  book  of  Dr.  Smith's.— Med.- 
Chir.  Review, 


A  work  such  as  the  present  is  therefore  highly 
useful  to  the  student,  and  we  commend  this  one 
to  their  attention. — American  Journal  of  Medical 
Sciences. 

No  operator,  however  eminent,  need  hesitate  to 
consult  this  unpretending  yet  excellent  book.  Those 
who  are  young  in  the  business  would  find  Dr.  Smith's 
treatise  a  necessary  companion,  after  once  under- 
standing its  true  character. — Boston  Me  J.  and  Surg. 
Journal. 


This  beautiful  little  work  has  been  compiled  with 
a  view  to  the  wants  of  the  profession  in  the  matter 
of  bandaging,  &c.,and  well  and  ably  has  the  author 
performed  his  labors.  Well  adapted  to  give  the 
requisite  information  on  the  subjects  of  which  it 
treats. — Medical  Examiner. 

The  directions  are  plain,  and  illustrated  through- 
out with  clear  engravings. — London  Lancet. 

One  of  the  best  works  they  can  consult  on  the 
subject  of  which  it  treats. — Southern  Journal  of 
Medicine  and  Pharmacy. 

BY   THE   SAME    AUTHOR,    AND 

HORNER  (WILLIAM   E.)f  M.  D., 

Late  Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

AN  ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body. 

In  one  volume,  large  imperial  octavo,  with  about  six  hundred  and  fifty  beautiful  figures. 

These  figures  are   well   selected,   and   present  a     late  the  student  upon  the  completion  of  this  Atlas, 


No  young  practitioner  should  be  without  this  little 
volume;  and  we  venture  to  assert,  that  it  maybe 
consulted  by  the  senior  members  of  the  profession 
with  more  real  benefit,  than  the  more  voluminous 
works. —  Western  Lancet. 


complete  and  accurate  representation  of  that  won- 
derful fabric,  the  human  body.  The  plan  of  this 
Atlas,  which  renders  it  so  peculiarly  convenient 
for  the  student,  and  its  superb  artistical  execution, 
have  been  already  pointed  out.     We  must  eongrato- 


as  it  is  the  most  convenient  work  of  the  kind  that 
has  yet  appeared  ;  and  we  must  add,  the  very  beau- 
tiful manner  in  which  it  is  ■'  got  up-'  is  so  creditable 
to  the  country  as  to  be  flattering  to  our  national 
pride. — American  Medical  Journal. 


SARGENT   iF.  W.),    M.  D. 

ON  BANDAGING  AND  OTHEi;  OPERATIONS  OF  MINOR  SURGERY. 

Second  edition,  enlarged.  One  handsome  royal  L2mo.  vol.,  of  nearly  400  pages,  with  182  wood-cuts. 

{Now  Ready.) 

The  very  best  manual  of  Minor  Surgery  we  have 
seen;  an  American  volume,  with  nearly  four  hundred 
pages  of  good  practical  lessons,  illustrated  by  about 
one  hundred  and  thirty  wood-cuts.     In  thes^ 


days 

of  "trial,"  when  a  doctor's  reputation  hangs  upon 
a  clove  hitch,  or  the  roll  of  a  bandage,  it  Would  he 
well,  perhaps,  to  carry  such  a  volume  as  Air 


We  have  carefully  examined  this  work,  and  find  it 
well  executed  and  admirably  adapted  to  the  use  of 
the  student.  Besides  the  subjects  usually  embraced 
in  works  on  Minor  Surgery,  there  is  a  short  chapter 
on  bathing,  another  on  anaesthetic  agents,  and  an 
appendix  of  formulae.  The  author  has  given  an  ex- 
cellent work  on  this  subject, and  Ins  publishers  have 


gent's  always  in  our  coat-pocket,  or,  at  all  i  vents,     illustrated  and  printed  it  in  most  beautiful  style. — 
to  listen  attentively  to  his  instructions  at  home  —     The  Charleston  Medical  Journal. 
Buffalo  Med.  Journal. 


SKEY  (FREDERICK  C),   F.  R.  S.,  &c. 
OPERATIVE  SURGERY.     In  om    very  handsome  octavo  volume  of  over  650 
pages,  with  about  one  hundred  wood-cut> 

SHARPEY  (WILLIAM),    rV       >.,    JONES   QUAIN,    M.D.,   AND 
RICHARD   QUAIN,    F.  R.  S.,  &c. 

HUMAN  ANATOMY.     Revised,  with  Notes  and  Additions,  by  Joseph  Leidy, 

M.  D.     Complete  in  two  large  octavo  volumes,  of  about  thirteen  hundred  pages.     Beautifully 
illustrated  with  over  five  hundred  engra\  ings  on  wood. 

We  have  no  hesitation  in  recommending  this  trea- 
tise on  anatomy  as  the  most  complete  on  that  sub- 
ject in  the  English  language ;  and  the  only  one, 
perhaps,  in  any  language,  which  brings  the  state 
of  knowledge  forward  to  the  most  recent  disco- 
veries.— The  Edinburgh  Med.  and  Surg.  Journal. 

Admirably  calculated  to  fulfil  the  object  for  which 
it  is  intended. — Provincial  Medical  Journal. 


It  is  indeed  a  work  calculated  to  make  an  in 

anatomical  study,  by  placing  before  the  student 
every  department  of  his  science,  with  a  view  to 
the  relative  importance  of  each ;  and  so  skilfully 
have  the  different  parts  been  interwoven,  n  i  no 
one  who  makes  this  work  the  basis  of  his  studies, 
will  hereafter  have  any  excuse  for  neglecting  ir 
undervaluing  any  important  particulars  coin.'"  ed 
with  the  structure  of  the  human  frame,  nd 
whether  the  bias  of  his  mind  lead  him  in  a  ml  re 
especial  manner  to  surgery,  physic,  or  physiology, 
he  will  find  here  a  work  at  once  so  compreli  isive 
and  practical  as  to  defend  him  from  exclusi 
on  the  one  hand,  and  pedantry  on  the  01 
Journal   and  Retrospect  of  the   Medical  S  ' 


The  most  complete  Treatise  on  Anatomy  in  the 
English  language. — Edinburgh  Medical  Journal. 

There  is  no  work  in  the  English  language  to  be 
preferred  to  Dr.  Quain's  Elements  of  Anatomy. — 
London  Journal  of  Medicine. 


In  one  volume,  octavo, 


STANLEY  (EDWARD). 
A  TREATISE  ON  DISEASES  (  '■■    THE  BONES. 

extra  cloth,  2S6  pages. 

SOLLY  (SAMUEL),   F.  R.  S. 
THE    HUMAN    BRAIN;    its  Structure,  Physiology,  and  Diseases.     With  a 

Description  of  the  Typical  Forms  of  the   I'.iain  in  the  Animal  Kingdom.     From  the  Second  and 
much  enlarged  London  edition.     In  one  octavo  volume  of  500  pages,  with  120  wood-cuts. 


AND    SCIENTIFIC    PUBLICATIONS.  29 


STILLE  (ALFRED),    M.  D. 

PRINCIPLES    OF    GENERAL    AND    SPECIAL    THERAPEUTICS.     In 

handsome  octavo.     (Preparing.) 

SIMON   (JOHN),  F.  R.  S. 
GENERAL    PATHOLOGY,    as   conducive  to  the   Establishment  of  Rational 

Principles  for  the  Prevention  and  Cure  of  Disease.  A  Course  of  Lectures  delivered  at  St. 
Thomas's  Hospital  during  the  summer  Session  of  1850.  In  one  neat  octavo  volume,  of  212 
pages. 

SMITH   (W.   TYLER),   M.D., 

Physician  Accoucheur  to  St.  Mary's  Hospital,  &c. 

ON   PARTURITION,    AND   THE    PRINCIPLES    AND   PRACTICE    OF 

OBSTETRICS.     In  one  large  duodecimo  volume,  of  400  pages. 

by  the  same  author. — (Now  Ready.) 

A  PRACTICAL  TREATISE  ON  THE  PATHOLOGY  AND  TREATMENT 

OF  LETJCORRHOZA.  With  numerous  illustrations.  In  one  very  handsome  octavo  volume  ot 
about  250  pages. 


The  investigation  of  the  pathology  and  treatment 
of  leucorrhcen  is  a  task  that  may  well  engage  the 
time  and  energies  of  the  most  philosophical  and 
skilled  physician  ;  and  there  are  few  men  more  capa- 
ble of  conducting  and  deducing  important  observa- 
tions from  sucli  a  study  than  the  author  of  the  pre- 
sent treatise.  l;r.  Tyler  Smith's  previous  researches, 
not  less  than  his  devotion  to  physiology  and  scientific 
medicine,  point  him  out  as  one  eminently  Calculated 
to  throw  light  on  many  subjects,  which  less  able 
men  might  fail  to  elucidate.  We  consequently  take 
his  work  in  hand  with  high  expectations  and  we 
have  not  been  in  the  least  disappointed.  The  fore- 
going  cursory   examination   of  Dr.   Tyler  Smith's 


work  will  be  sufficient  to  prove  its  value,  and  we 
hope  more  than  enough  to  induce  every  practitioner 
to  study  it  for  himself. — Tke  Lancet. 

The  above  list  contains  simply  the  general  head- 
ings of  the  different  chapters;  to  have  enumerated 
all  the  subjects  discussed,  or  to  have  made  further 
extracts,  would  have  compelled  us  much  to  exceed 
our  limits.  This,  however,  we  scarcely  regret; 
because  we  think  a  perusal  of  the  extracts  given 
will  induce  the  reader  to  examine  the  work  for  him- 
self; and  we  would  advise  all  who  are  anxious  for 
correct  ideas  respecting  these  discharges,  and  their 
sources,  to  possess  themselves  of  it. — Dublin  Med. 
Press. 


SIBSON   (FRANCIS),    M.D., 

Physician  to  St.  Mary's  Hospital. 

MEDICAL  ANATOMY.     Illustrating  the  Form,  Structure,  and  Position  of  the 

Internal  Organs  in  Health  and  Disease.     In  large  imperial  quarto,  with  splendid  colored  plates. 
To  match  "Maclise's  Surgical  Anatomy."     Part  I.     (Nearly  Ready.) 


SCHOEDLER  iFRIEDRICH),   PH.D., 

Professor  of  the  Natural  Sciences  at  Worms,  &c. 

THE   BOOK   OF   NATURE;    an  Elementary  Introduction  to  the  Sciences  of 

Physics,  Astronomy,  Chemistry,  Mineralogy,  Geology,  Botany,  Zoology,  and  Physiology.  First 
American  edition,  with  a  Glossary  and  oilier  Additions  and  Improvements;  from  the  second 
English  edition.  Translated  from  the  sixih  German  edition,  by  Henry  Mkdlock,  F.  C.  S.,  &c. 
In  one  thick  volume,  small  octavo,  of  about  seven  hundred  pages,  with  G79  illustrations  on  wood. 
Suitable  for  the  higher  Schools  and  private  students.     (Now  Ready.) 

TOMES  (JOHN),    F.  R.  S. 
A  MANUAL  OF  DENTAL  PRACTICE.     Illustrated  by  numerous  engravings 

on  wood.     In  one  handsome  volume.     (Preparing.) 


.  TRANSACTIONS  OF   THE   AMERICAN    MEDICAL   ASSOCIATION. 
VOLUME  VIII,  for  1855,  8vo.,  extra  cloth.      (Nearly  Ready.) 

A  few  complete  sets  can  still  be  had,  in  eight  volumes,  price  $38.     Applications  and  remittances 

to  be  made  to  Caspar  Wister,  M.  D.,  Tivu-urer,  Philadelphia. 
*#*  These  volumes  are  published  by  and  sold  for  account  of  the  Association. 

TODD  (R.  B.),   M.  D.,  AND   BOWMAN  (WILLIAM),   F.  R.  S. 
PHYSIOLOGICAL    ANATOMY    AND    PHYSIOLOGY  OF  MAN.     With 

numerous  handsome  wood-cuts.    Parts  I,  IJ,  and  III,  in  one  octavo  volume,  552  pages.     Part  IV 

will  complete  the  work. 

The  first  portion  of  Part  IV,  with  numerous  original  illustrations,  was  published  in  the  Medical 
News  and  Library  for  1853,  and  the  completion  will  be  issued  immediately  on  its  appearance  in 
London.  Those  who  have  subscribed  since  the  appearance  of  the  preceding  portion  of  the  work 
oan  have  the  three  parts  by  mail,  on  remittance  of  $2  50  to  the  publishers. 


TOYNBEE  (JOSEPH),   F.  R.  S., 

Aural  Surgeon  to  St.  Mary's  Hospital,  &c. 

A  MANUAL  OF  AURAL  SURGE  RY;  being  a  complete  Treatise  on  Diseases 

of  the  Ear.     Illustrated  with  numerous  engravings  on  wood,  from  original  drawings.     In  one 
octavo  volume.     (Preparing.) 


30  BLANCHARD    &    LEA'S    MEDICAL 

TANNER   (T.    H.),    M.  D. 

Physician  to  the  Hospital  for  Women,  &c. 

A  MANUAL  OF  CLINICAL  MEDICINE  AND  PHYSICAL  DIAGNOSIS. 

To  which  is  added  The  Code  of  Elhics  of  the  American  Medical  Association.     In  one  neat 

volume,  small  12mo.,  extra  cloth.  (Note  Ready.) 

The  object  of  this  little  work  is  to  furnish  the  practitioner,  in  a  condensed  and  convenient  com- 
pass, and  at  a  trifling  cost,  with  a  guide  for  the  daily  exigencies  of  his  practice.  A  large  portion  of 
the  volume  is  occupied  with  details  of  diagnostic  symptoms,  classified  under  the  different  seats  of 
disease.  This,  in  itself,  is  well  worth  the  price  of  the  book,  but  in  addition,  there  will  be  found  an 
immense  amount  of  information,  not  usually  touched  upon  in  the  systematic  works,  or  scattered 
throughout  many  different  volumes — such  as  general  rules  for  conduct,  taking  notes,  clinical  exami- 
nation of  children  and  of  the  insane,  post-mortem  examinations,  medico-legal  examinations,  exami- 
nations for  life  insurance,  instruments  employed  in  diagnosis,  such  as  the  microscope,  tests,  the 
spirometer,  dynamometer,  stethometcr,  stethoscope,  pleximeter,  ophthalmoscope,  speculum,  uterine 
*ound,  &c. ;  directions  for  the  chemical  and  microscopical  examination  of  the  blood,  urine,  sputa, 
&c.  &c. ;  with  many  other  subjects  of"  equal  importance  which  hitherto  the  young  practitioner  has 
had  to  learn  in  a  great  measure  from  experience  alone.  Although  necessarily  treated  in  a  condensed 
manner,  the  topics  will  be  found  to  embrace  the  latest  and  most  approved  modes  of  procedure,  while 
the  addition  of  the  admirable  "  Code  of  Ethics"  of  the  American  Medical  Association  renders  it 
complete  as  a  guide  for  the  student  and  as  a  manual  of  daily  reference  for  the  younger  practitioner. 

Those  who  desire  to  u<e  it  as  a  vade-mecum  for  the  pocket,  can  obtain  copies  neatly  done  up  in 
flexible  cloth. 

TAYLOR  (ALFRED  S.),  M.  D.,  F.  R.  S., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Guy's  Hospital. 

MEDICAL  JURISPRUDENCE.     Third  American,  from  the  fourth  and  improved 

English  Edition.    With  Notes  and  References  to  American  Decisions,  by  Edward  Hartshorne, 
M.  D.     In  one  large  octavo  volume,  of  about  seven  hundred  pages.     (Just  fssned.) 
We  know  of  no  work  on  Medical  Jurisprudence    none  could   be   offered   to   the  busy  practitioner  of 
which  contains  in  the  same  space  anything  like  the    either  calling,  for  the.  purpose  of  casual   or  hasty 
same  amount  of  valuable  matter — If.  Y.  Journal  of    reference,  that  would  be  more  likely  to  afford  the  aid 
Medicine,  desired.     We  therefore  recommend  it  as  the  best  and 

No  work  upon   the   subject  can  be  put  into  the  i  s,l/est  manual  for  daily  we.— American  Journal  of 
hands  of  students  either  of  law  or   medicine  which     Medical  Sciences. 
will  engage  them  more  closely  or  profitably  j  and  j 

BY    THE    SAME   AUTHOR. 

ON  POISONS,  IN  RELATION  TO  MEDICAL  JURISPRUDENCE   AND 

MEDICINE.    Edited,  with  Notes  and  Additions,  by  R.  E.  Griffith,  M.  D.    In  one  large  octavo 
volume,  of  6S8  pages. 


The  most  elaborate  work  on  the  subject  that  our 
literature  possesses. — British  and  Foreign  Mtdiro- 
Chirur§ical  Review. 


One  of  the  most  practical  and  trustworthy  works 
on  Poisons  in  our  language. — Western  Journal  oj 
Medicine . 


THOMSON  (A.  T.),  M .  D.,  F.  R.  S.,  &c. 
DOMESTIC  MANAGEMENT   OF   THE   SICK  ROOM,  necessary  in  aid  of 

Medical  Treatment  for  the  Cure  of  Diseases.     Edited  by  R.  E.  Griffith,  M.  D.     In  one  large 
royal  12mo.  volume,  with  wood-cuts,  360  pages 

WATSON    (THOMAS),    M.D.,    &c. 
LECTURES    ON    THE    PRINCIPLES    AND    PRACTICE   OP   PHYSIC. 

Third  American,  from  the  last  London  edition.    Revised,  with  Additions,  by  D.  Francis  Condie, 

M.  D  .  author  of  a  "Treatise  on  the  Diseases  of  Children,"  &c.     In  one  octavo  volume,  of  nearly 

eleven  hundred  large  pages,  strongly  bound  with  raised  bands* 

To  say  that  it  is  the  very  best  work  on  the  sub-  I      Confessedly  one   of  the  very  best  works  on  the 
ject  now  extant,  is  but  to  echo  the  sentiment  of  the  ;  principles  and  practice  of  physic  in  the  English  or 
medical    press    throughout    the    country.  —  N.   O.    any  other  language. — Med.  Examiner. 
Medical  Journal.  Asa  text-book  it  hasnoequal;  as  a  compendium 

Of  the  text-books  recently  republished  Watson  is  [  <*  pathology  and  practice  no  superior.— New  York 
very  justly  the  principal  favorite. — Holmes's  Rep.     Annalist 


to  Nat.  Med.  Assoc. 

By  universal  consent  the  work  ranks  among  the 
very  best  text-books  in  our  language. — Illinois  and 
Indiana  Med.  journal. 

Regarded  on  all  hands  as  one  of  the  very  best,  if 
not  the  very  best,  systematic  treatise  on  practical 


medicine  extant. — St.  Louis  Med.  Journal.  I  Journal 


We  know  of  no  work  better  calculated  for  being 
placed  in  the  hands  of  the  student,  and  fur  a  text- 
book; on  every  important  point  the  author  seems 
to  have  posted  up  his  knowledge  to  the  day. — 
Amer.  Med.  Journal. 

One  of  the  most  practically  useful  books  that 
ever  was  presented  to   the   student.  —  N.  Y.  Med. 


WHAT   TO   OBSERVE 
AT    THE    BEDSIDE    AND    AFTER   DEATH,    IN    MEDICAL    CASES. 

Published  under  the  authority  of  the  London  Society  for  Medical  Observation.     A  new  American, 

from  the  second  and  revised  London  edition.     In  one  very  handsome  volume,  royal  12mo.,  extra 

cloth.     (Now  Ready.) 

The  demand  which  has  so  rapidly  exhausted  the  first  edition  of  this  little  work,  shows  that  the 
advantages  it  offers  to  the  profession  have  been  duly  appreciated,  and  has  stimulated  the  authors  to 
render  it  more  worthy  of  its  reputation.  It  has  therefore  been  thoroughly  revised,  and  such  im- 
provements (among  which  is  a  section  on  Treatment)  have  been  made  as  further  experience  in 
its  use  has  shown  to  be  desirable. 

To  the  observer  who  prefers  accuracy  to  blunders  I  One  of  the  finest  aids  to  a  young  practitioner  we 
and  precision  to  carelessness,  this  little  book  is  in-     have  ever  seen. — Peninsular  Journal  of  Medicine . 


AND    SCIENTIFIC    PUBLICATIONS.  31 


WILSON    (ERASMUS),   M.D.,    F.  R.  S., 

Lecturer  on  Anatomy,  London. 

A  SYSTEM  OP  HUMAN  ANATOMY,  General  and  Special.  Fourth  Ameri- 
can, from  the  last  English  edition.  Edited  by  Paul  B.  Goddard,  A.  M.,  M.  D.  With  two  hun- 
dred and  fifty  illustrations.  Beautifully  printed,  in  one  large  octavo  volume,  of  nearly  six  hun- 
dred pages. 


In  many,  if  not  all  the  Colleges  of  the  Union,  it 
has  become  a  standard  text-book.  This,  of  itself, 
is  sufficiently  expressive  of  its  value.  A  work  very 
desirable  to  the  student;  one,  the  possession  of 
which  will  greatly  facilitate  his  progress  in  the 
study  of  Practical  Anatomy. — New  York  Journal  of 
Medicine. 

Its  author  ranks  with  the  highest  on  Anatomy. — 
Southern  Medical  and  Surgical  Journal. 


It  offers  to  the  student  all  the  assistance  that  can 
be  expected  from  such  a  work. — Medical  Examiner. 

The  most  complete  and  convenient  manual  for  the 
student  we  possess. — American  Journal  of  Medical 
Science. 

In  every  respect,  this  work  as  an  anatomical 
guide  for  the  student  and  practitioner,  merits  our 
warmest  and  most  decided  praise. — London  Medical 
I  Gazette. 

BY   THE   SAME   AUTHOR. 

THE    DISSECTOR;    or,  Practical  and  Surgical  Anatomy.     Modified   and  Re- 
arranged, by  Paul  Beck  Goddard,  M.  D.    A  new  edition,  with  Revisions  and  Additions.    In 
one  large  and  handsome  volume,  royal  12mo.,  of  458  pages,  with  115  illustrations. 
In  passing  this  work  again  through  the  press,  the  editor  has  made  such  additions  and  improve- 
ments as  the  advance  of  anatomical  knowledge  has  rendered  necessary  to  maintain  the  work  in  the 
high  reputation  which  it  has  acquired  in  the  schools  of  the  United  Slates,  as  a  complete  and  faithful 
guide  to  the  student  of  practical  anatomy.     A  number  of  new  illustrations  have  been  added,  espe- 
cially in  the  portion  relating  to  the  complicated  anatomy  of  Hernia.     In  mechanical  execution  the 
work  will  be  found  superior  to  former  editions. 

BY   THE   SAME   AUTHOR. 

ON    DISEASES    OF   THE    SKIN.     Third  American,  from  the  third  London 

edition.  In  one  neat  octavo  volume,  of  about  five  hundred  pages,  extra  cloih.  (Just  Issued.) 
Also,  to  be  had  done  up  with  fifteen  beautiful  steel  plates,  of  which  eight  are  exquisitely  colored  ; 
representing  the  Normal  and  Pathological  Anatomy  of  the  Skin,  together  with  accurately  colored 
delineations  of  more  than  sixty  varieties  of  disease,  most  of  them  the  size  of  nature.  The  Plates 
are  also  for  sale  separate,  done  up  in  boards. 

The  "Diseases   of  the  Skin,"   by  Mr.  Krasmns  I  nothing  to  be  desired,  so  far  as  excellence  of  delinea- 
Wilson,  may  now  be  regarded  as  the  standard  work  |  tion   and  perfect  accuracy  of  illustration  are  con- 
in    that   department  of    medical    literature.      The  I  cerned. — Medico-Chirurgical  Review. 
plates  by  which  this  edition  is  accompanied  leave  | 

BY   THE   SAME    AUTHOR. 

ON    CONSTITUTIONAL    AND    HEREDITARY    SYPHILIS,   AND    ON 

SYPHILITIC  ERUPTIONS.     In  one  small  octavo  volume,  beautifully  printed,  with  four  exqui- 
site colored  plates,  presenting  more  than  thirty  varieties  of  syphilitic  eruptions. 

BY  THE  same  author.     (Now  Ready.) 

HEALTHY  SKIN;  A  Popular  Treatise  on  the  Skin  and  Hair,  their  Preserva- 
tion and  Management.  Second  American,  from  the  fourth  London  edition.  One  neat  volume, 
royal  12mo.,  of  about  300  pages,  with  numerous  illustrations. 

Copies  can  be  had  done  up  in  paper  covers  for  mailing,  price  75  cents. 


WHITEHEAD  (JAMES),    F.  R.  C.  S.,    &.c. 
THE  CAUSES  AND  TREATMENT  OF  ABORTION  AND  STERILITY; 

being  the  Result  of  an  Extended  Practical  Inquiry  into  the  Physiological  and  Morbid  Conditions 
of  the  Uterus.     Second  American  Edition.     In  one  volume,  octavo,  368  pages.     (Now  Ready.) 


Such  are  the  advances  marie  from  year  to  year  in 
this  department  of  our  profession,  that  the  practi- 
tioner who  does  not  consult  the  recent  works  on  the 
complaints  of  females,  will  soon  find  himself  in  the 
rear  of  Ins  more  studious  brethren.     This  is  oue  o( 


the  works  which  must  be  studied  by  those  who 
would  know  what  the  present  state  of  our  knowledge 
is  respecting  the  causes  and  treatment,  of  abortion 
and  sterility. — The  Western  Journal  of  Medicine  and 

Surgery. 


WALSHE   (W.    H.),    M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 

DISEASES    OF    THE    HEART,    LUNGS,    AND    APPENDAGES;    their 

Symptoms  and  Treatment.     In  one  handsome  volume,  large  royal  12mo.,  512  pages. 

We  consider  this  as  the  ablest  work  in  the  En-  I  the  author  being  the  first  stethoscopist  of  the  day  — 
glish  language,  on  the  subject  of  which  it  treats;  |  Charleston  Medical  Journal. 

WILDE   (W.    R.), 
Surgeon  to  St.  Mark's  Ophthalmic  and  Aural  Hospital,  Dublin. 

AURAL  SURGERY,  AND  THE  NATURE  AND  TREATMENT  OF  DIS- 
EASES OF  THE  EAR.    In  one  handsome  octavo  volume  of  476  pages,  with  illustrations. 
This  work  certainly  contains  more  information  on 

the   subject  to  which  it  is   devoted    than   any   other 

with  which  we  are  acquainted.     We  feel  grateful  10 

the  author  for  his  manful  effort  to  rescue,  this  depart 

ment  of  surgery  from  the  hands  of  the  empirics  who 

nearly  monopolize  it.    We  think  he  hag  successfully 

shown  that  aural  diseases   are  not   beyond    the   re 

sources  of  art;  dial  they  are  governed  by  the  same 


laws,  and  amenable  to  the  same  general  methods  of 
Heat  ment  as  other  morbid  proces-rs  I'lie  work  is 
not  written  to  supply  the  cravings  of  popular  patro- 
nage, but  ii  is  wholly  addressed  to  the  profession, 
and  bears  on  every  page  the  impress  of  die  reflections 
of  a  sagacious  and  practical  surgeon. —  Va.  Sui .-.  and 
Med.  Journal. 


32  BLANCHARD   &   LEA'S    SCIENTIFIC  PUBLICAT  IONS. 

WEST   (CHARLES),    M.  D., 

Physician  to  the  Hospital  for  Sick  Children,  &c. 

LECTURES   ON   THE   DISEASES    OF  INFANCY  AND   CHILDHOOD. 

Second  American,  from  the  Second  and  Enlarged  London  edition.     In  one  volume,  octavo,  of 
nearly  five  hundred  pages.    (Just  Issued.) 


We  take  leave  of  Dr.  West  with  great  respect  for 
his  attainments,  a  due  appreciation  of  his  acute 
powers  of  observation,  and  a  deep  sense  of  obliga- 
tion for  this  valuable  contribution  to  our  profes- 
sional literature.  His  book  is  undoubtedly  in  many 
respects  the  best  we  possess  on  diseases  of  children. 
The  extracts  we  have  given  will,  we  hope,  satisfy 
our  readers  of  its  value;  and  yet  in  all  candor  we 
must  say  that  they  are  even  inferior  to  some  other 
parts,  the  length  of  which  prohibited  our  entering 
upon  them.  That  the  book  will  shortly  be  in  the 
hands  of  most  of  our  readers  we  do  not  doubt,  and  it 
will  give  us  much  pleasure  if  our  strong  recommend- 
ation of  it  may  contribute  towards  the  result. — The 
Dublin  Quarterly  Journal  of  Medical  Science. 

Dr.  West  has  placed  the  profession  under  deep  ob- 
ligation by  this  able,  thorough,  and  finished  work 


upon  a  subject  which  almost  daily  taxes  to  the  ut- 
most the  skill  of  the  general  practitioner.  He  has 
with  singular  felicity  threaded  his  way  through  all 
the  tortuous  labyrinths  of  the  difficult  subject  he  has 
undertaken  to  elucidate,  and  has  in  many  of  the 
darkest  corners  left  a  light,  for  the  benefit  of  suc- 
ceeding travellers,  which  will  never  be  extinguished. 
Not  the  least  captivating  feature  in  this  admirable 
performance  is  its  easy,  conversational  style,  which 
acquires  force  from  its  very  simplicity,  and  leaves 
an  impression  upon  the  memory,  of  the  truths  it 
conveys,  as  clear  and  refreshing  as  its  own  purity. 
The  author's  position  secured  him  extraordinary  fa- 
cilities for  the  investigation  of  children's  diseases, 
and  his  powers  of  observation  and  discrimination 
have  enabled  him  to  make  the  most  of  these  great 
advantages. — Nashville  Medical  Journal. 


BY  the  same  author.     (Just  Issued) 

AN  ENQUIRY  INTO  THE  PATHOLOGICAL  IMPORTANCE  OF  ULCER- 
ATION OF  THE  OS  UTERI.  Being  the  Croonian  Lectures  for  the  year  1854.  In  one  neat 
octavo  volume,  extra  cloth. 


WILLIAMS  (C.  J.  B.),    M.D.,    F.  R.  S., 

Professor  of  Clinical  Medicine  in  University  College,  London,  &c. 

PRINCIPLES   OF  MEDICINE;   comprising  General  Pathology  and  Therapeu- 

tics,  and  a  brief  general  view  of  Etiology,  Nosology,  Semeiology,  Diagnosis,  Prognosis,  and 
Hygienics.  Edited,  with  Additions,  by  Meredith  Clymer,  M.  D.  Fourth  American,  from  the 
last  and  enlarged  London  edition.     In  one  octavo  volume,  of  476  pages.     {Lately  Issued.) 

It  possesses  the  strongest  claims  to  the  attention  of  the  medical  student  and  practitioner,  from 
(he  admirable  manner  in  which  the  various  inquiries  in  the  different  branches  of  pathology  are 
investigated,  combined,  and  generalized  by  an  experienced  practical  physician,  and  directly  applied 
to  the  investigation  and  treatment  of  disease. — Editor's  Preface. 

The  best  exposition  in  our  language,  or,  we  be-  I  Few  books  have  proved  more  useful,  or  met  with 
lieve,  in  any  language,  of  rational  medicine,  in  its  |  a  more  ready  sale  than  this,  and  no  practitioner 
present  improved  and  rapidly  improving  state. —  I  should  regard  his  library  as  complete  without  it. 
British  and  Foreign  Medico-Chirurg.  Review.  |  — Ohio  Med.  and  Surg.  Journal. 

BY    THE   SAME   AUTHOR. 

A  PRACTICAL  TREATISE  ON  DISEASES   OF  THE   RESPIRATORY 

ORGANS;  including  Diseases  of  the  Larynx,  Trachea,  Lungs,  and  Pleurae.  With  numerous 
Additions  and  Notes,  by  M.  Clymer,  M.  D.     With  wood-cuts.     In  one  octavo  volume,  pp.  508. 


YOUATT   (WILLIAM),  V.  S. 
THE    HORSE.      A  new  edition,  with  numerous  illustrations;   together  with  a 

general  history  of  the  Horse;  a  Dissertation  on  the  American  Trotting  Horse  ;  how  Trained  and 
Jockeyed :  an  Account  of  his  Remarkable  Performances ;  and  an  Essay  on  the  Ass  and  the  Mule. 
By  J.  S.  Skinner,  formerly  Assistant  Postmaster-General,  and  Editor  of  the  Turf  Register. 
One  large  •^•»^vo  volume. 

BY   THE   SAME   AUTHOR. 

THE   DCG.     Edited  by  E.  J.  Lewis,   M.  D.     With   numerous   and  beautiful 

illustrations.     In  one  very  handsome  volume,  crown  Svo.,  crimson  cloth,  gilt. 

ILLUSTRATED  MEDICAL  CATALOGUE. 

BLANCHARD  &  LEA  have  now  ready  a  Catalogue  of  their  Medical,  Surgical,  and  Scien- 
tific Publications,  containing  descriptions  of  the  works,  with  Notices  of  the  Press,  and 
specimens  of  the  Illustrations,  making  a  pamphlet  of  sixty-four  large  octavo  pages.  It  has 
been  prepared  with  great  care,  and  without  regard  to  expense,  forming  one  of  the  most  beau- 
tiful specimens  of  typographical  execution  as  yet  issued  in  this  country.  Copies  will  be 
sent  by  mail,  and  the  postage  paid,  on  application  to  the  Publishers,  by  inclosing  two  three 
cent  postage  stamps. 

Catalogues  of  Blanchard  &  Lea's  numerous  Miscellaneous  and  Educational  Publications 
will  be  forwarded  free  by  mail,  on  application. 


X 


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